» 







~2 




LI BRARY OF CONGRE SS. | 

[SMITHSONIAN DEPOSIT.] j 



^/l) bm 75 



{ UNITED STATES OF AMERICA. J 




ON 

ANATOMY, MEDICINE, SURGERY, 
MIDWIFERY, 




PUBLISHED DURING THE PRESENT YEAR, 

BY 

MR. CHURCHILL, 




T. C. SiTIIL, PRINTER. 



2 WORKS ON ANATOMY, SURGERY, MIDWIFERY, ETC. 



NEW WORKS. 



OBSERVATIONS ON THE STRUCTURE & DISEASES 

of the TESTIS. By Sir Astley Cooper, Bart., F.R.S., Serjeant-Surgeon 
to the Queen, Consulting Surgeon to Guy's Hospital. One royal 4to volume, 
illustrated with numerous highly finished coloured plates, (in the press.) 
*** The Publisher has much pleasure in announcing a New Edition of the 

above splendid work, which has been so long out of print ; the whole has been 

carefully revised, with additions by the respected author. 



ON THE NATURE AND TREATMENT OF STOMACH 

AND URINARY DISEASES ; being an Inquiry into the Connexion of 
Diabetes, Calculus, and other Affections of the Kidney and Bladder with 
Indigestion. By William Prout, M.D., F.R.S. The Third Edition, 8vo, 
with Six Engravings, (now ready.) 
*** This Edition has been re-written, and contains a considerable addition of 
new and important matter. The Author, in presenting to the public the results 
of nearly thirty years' observation and experience, has still kept in view, as 
much as possible, the practical character of his treatise. 



THE PATHOLOGY AND DIAGNOSIS OP DISEASES OF 

THE CHEST ; illustrated chiefly by a Rational Exposition of their Physical 
Signs. By Charles J. B. Williams, M.D., F.R.S., Professor of the 
Practice of Medicine, University College, London. 
The 4th Edition, 8vo, with much important new matter, Plates, nearly ready. 



THE ANATOMIST'S YADE-MECUM ; A SYSTEM OF 

HUMAN ANATOMY. By W. J. Erasmus Wilson, Lecturer on j 
Anatomy and Physiology at the Middlesex Hospital Medical School. 
Foolscap 8vo, cloth, 12 s. 6d. 

The design of the "Anatomist's Vade-Mecum" is to present to the profession, 
and particularly to the student, a systematic work, to which he may refer with 
confidence for a complete digest of the present state of the science of Anatomy, 
and which shall record the newest researches and discoveries. In the present 
work, the fulfilment of these objects is insured in the name and reputation of the 
Author, and no expense has been spared in wood-cut illustrations to render it 
the MOST BEAUTIFUL AND PERFECT VOLUME THAT HAS 
EVER BEEN PLACED IN THE HANDS OF THE STUDENT. In 
the arrangements of subjects great care has been observed to avoid complexity 
of description, and to adopt so clear and concise a style as shall impress the facts 
forcibly on the mind, and facilitate their conception and acquirement. 

[For Specimens of the Illustrations see opposite page.~\ 



m 



n — 

4 WORKS ON ANATOMY, SURGERY, MIDWIFERY, ETC. 



PRACTICAL REMARKS ON THE DISCRIMINATION 

AND APPEARANCES OF SURGICAL DISEASES. One volume, 
8vo. By John Howship, Esq., Surgeon to the Charing Cross Hospital. 
(in the press.) _____ 

PATHOLOGICAL OBSERVATIONS ON THE DISEASES 

OF THE UTERUS. By Robert Lee, M.D., F.R.S., Lecturer on Mid- 
wifery at St. George's Hospital. Part I. Imperial 4to, with Four highly 
finished Coloured Drawings hy Mr. Perry. Price 14s. 
This work will illustrate, by cases and coloured plates, the nature, symptoms, 
and treatment of 

I. Malignant diseases of the Uterus. 

II. Fibrous, Calcareous, and other Tumours of the Uterus, which do not 
assume a malignant form. 

III. Inflammation, and the various morbid conditions of the Uterus, by which 
its functions are disturbed, but which seldom produce any permanent 
alteration of the structure of its component parts. 

IV. Diseases of the Ovaria, Fallopian Tubes, and External Uterine ap- 
pendages. 

V. Diseases of the Gravid Uterus and its contents. 

" This work will prove a magnificent contribution to medical science. Four plates, 
executed in the first style of art, are given in illustration."— Medical Gazette. 



MEDICAL AND PHYSIOLOGICAL COMMENTARIES. 

By Martyn Paine, A.M., M.D., Professor of the Theory and Practice of 
Medicine in the University of New York. Two volumes 8vo, comprising 
1530 pages, price £1. 18 s. 
The subjects examined relate to obscure and controverted questions in Patho- 
logy, and embrace a critical review of some of the most important doctrines in 
Physiology and Medicine. 

A PRACTICAL TREATISE ON THE BILIOUS REMIT- 

TENT FEVER ; its History, Causes, Effects, and Treatment, with Experi- 
ments on the temperature of the system in health, and when labouring under 
the disease in its different stages, and in the paroxysms of the Tertian or 
Intermittent Fever ; together with remarks on the connexion of diseases 
with the changes of the atmosphere upon Epidemics ; Medical Topography, 
illustrated by Diagrams ; and Statistics of the Naval Squadron , on the West 
India Station. By William Arnold, M.D., Fellow of the Royal College 
of Physicians, Edinburgh ; Member of the Wernerian and other learned 
Societies, &c. &c. 8vo, cloth, (just beady.) 



PRACTICAL OR OPERATIYE SURGERY. 

By Robert Liston, Esq., Surgeon to the North London Hospital. The 
Third Edition, 8vo, cloth, (now ready.) 
*** This edition has been carefully revised throughout by the Author, is illus- 
trated with additional wood-cuts, and contains much important new matter. 
[For Specimens of the Illustrations see opposite page.'] 




6 WORKS ON ANATOMY, SURGERY, MIDWIFERY, ETC. 



ON THE ANATOMY, PHYSIOLOGY, AND PATHOLOGY 

OF THE EAR ; being the Prize Essay in the University of Edinburgh. 

By Joseph Williams, M.D., Member of the Royal College of Surgeons. 

One 8vo volume, with plates, price 10s. 6d. 
" We are glad that this neglected branch of Surgery is in a fair way of attracting the atten- 
tion which on every account it merits. We can recommend Dr. Williams's work as con- 
taining much interesting and useful information." — Dublin Medical Press. 



TRANSACTIONS OP THE PROVINCIAL MEDICAL 

AND SURGICAL ASSOCIATION ; Volume VIII. 8vo, cloth, price 
£1. lis. 6d., containing : — 

I. The Report of the Section appointed to inquire into the present state of 
Vaccination, as read at the Anniversary Meeting of the Provincial Medical and 
Surgical Association, held at Liverpool, July 25, 1839. 

II. The Retrospective Address delivered at the Seventh Anniversary Meet- 
ing of the Provincial Medical and Surgical Association, held at Liverpool, July 
24th and 25th, 1839. By John Addington Symonds, M.D., Senior Physician 
to the Bristol General Hospital, Lecturer on the Practice of Medicine, &c. &c. 

III. Retrospective Address in Surgery, from July, 1836, to July 1839, deli- 
vered at Liverpool, July 24th, 1839. By J. H. James, Esq., Surgeon to the 
Devon and Exeter Hospital. 

IV. Observations on the Variola? Vaccinae, as they occasionally appear in the 
Vale of Aylesbury, with an account of some recent Experiments in the Vacci- 
nation, Retro-vaccination, and Variolation of Cows. By Robert Ceelt, Esq., 
Surgeon to the Buckinghamshire Infirmary. (Illustrated by 35 Coloured 
Engravings from Original Drawings.) 

" The eighth volume of the Transactions of the Association has just made its appearance ; 
but, we regret to say, at so late a period of the quarter, as to preclude our giving any detailed 
account of its contents. We cannot, however, let the opportunity pass of calling the atten- 
tion of the profession, in this and other countries to the most valuable memoir of Mr. Ceeley 
contained in it, entitled « Observations on the Variolar Vaccinae as they occasionally appear 
in the Vale of Aylesbury, with an account of some recent experiments on the Vaccination, 
Retro-vaccination, and Variolation of Cows.' This memoir extends to 150 pages, and is 
illustrated by thirty-five beautifully coloured plates. We entirely concur in the following 
judgment pronounced on this paper by the council in the preface to the volume : * Several 
questions of the utmost interest to the welfare of the community generally, as well as the 
medical science, will be found to be most ably investigated. The variolation of the cow has 
been satisfactorily accomplished, with the effect of thereby generating the vaccine ; the cha- 
racters of the vaccine in the cow, with several of its irregularities, are carefully described and 
figured, and some of the most nearly allied spurious forms pointed out, by attention to which 
many of the difficulties attendant upon a recurrence to the cow for renewed supplies of the 
vaccine may be obviated. Considerable light has also been thrown upon the value of the 
practice of retro-vaccination as a means of renewing and restoring the properties of lymph 
presumed to be deteriorated or otherwise altered by repeated transmissions through the 
human body ; while the paper altogether must form a standard of reference for those who 
are engaged in the endeavour to extend and perfect the vaccine as a means of protecting 
millions from the fatal ravages of the smallpox." — British and Foreign Medical Review, 
July, 1840. 

To be had separately, 
REPORT of the VACCINATION SECTION of the ASSOCIATION. 

Price 2s. 

OBSERVATIONS on the VARIOLA VACCINAE, (illustrated by Coloured 
Engravings.) By R. CEELY, Esq. Price 21s. 




t 



PUBLISHED BY MR, CHURCHILL. 



7 



A COMPENDIUM OF MATERIA MEDICA & PHARMACY; 

Adapted to the London Pharmacopoeia, emhodying all the New French, 
American, and Indian Medicines, and also comprising a Summary of Practical 
Toxicology. By J. Hunter Lane, M.D. F.L.S. F.S.S.A. One neat pocket 
volume, 5 s. cloth. 

" Dr. Lane's volume is on the same general plan as Dr. Thompson's long known Con- 
spectus ; but it is much fuller in its details, more especially in the chemical department. It 
seems carefully compiled, is well suited for its purpose, and cannot fail to be useful." — 
British and Foreign Medical Review. 

"This work contains a concise but comprehensive account of all the simple and com- 
pound medicines in use ; it contains a greater amount of chemical information than we 
often meet with in a small work on Pharmacy. The work is worthy of recommendation." — 
Lancet. 



APHORISMS ON THE TREATMENT & MANAGEMENT 

of the INSANE ; with Considerations on Public and Private Lunatic 
Asylums, pointing out the errors in the present system. By J. G. Millingen, 
M.D., late Resident Physician of the Middlesex Pauper Lunatic Asylum at j 
Hanwell, and formerly Superintendent of the Army Lunatic Asylum at 
Chatham. 18mo, cloth, 4s. 6d. 
"Dr. Millingen, in one small pocket volume, has compressed more real solid matter 
than could be gleaned out of any dozen of octavos on the same subject. We recommend 
this vade mecum as the best thing of the kind we ever perused." — Dr. Johnson's Review. 



A TREATISE ON AEEECTIONS AND DISEASES OF THE 

VERTEBRAL COLUMN, CONTRACTIONS of the CHEST, PRO- 
JECTIONS of the SHOULDER, HIP, &c. This work will contain a 
new and successful Plan of Treatment, without confining the Patient con- 
stantly to the recumbent position. It will also be illustrated by Plates 
and numerous cases. By E. W. Tuson, F.R.S., F.L.S., Surgeon to the 
Middlesex Hospital, (nearly ready.) 



BRITISH AND FOREIGN MEDICAL REVIEW. 

Edited by John Forbes, M.D. F.R.S. 

" We have now, for the first time, a Medical Review from the British press, deserving of 
comparison with the most celebrated of the Journals devoted to literature and general science. 
The articles do not consist simply of an analysis of the work subject to examination ; but of 
a critical digest of all the information therein contained, and of all that can be gathered from 
other sources unnoticed by the author. The most profound research, extensive experience, 
and critical acumen, are brought to bear upon the subjects discussed ; and the consequence 
is, a more satisfactory epitome of the state of medical science at the present time than we 
have met with in any other work which has come under our observation. The execution of 
the mechanical part is fully equal to the literary ; and we have no hesitation in pronouncing 
The British and Foreign Medical Review the first medical periodical in the world." — 
The American Medical Library and Intelligencer. 

" The British and Foreign Medical Review is certainly the ablest periodical now published 
in England." — Journal of the Calcutta Medical and Physical Society, Dec. 1837. 

THE BRITISH AND FOREIGN MEDICAL REVIEW is published 
Quarterly, price Six Shillings. The first ten volumes may be had, elegantly done 
up in Cloth Boards, with Gold Letters, at the same price as the single Numbers. 

*** No. XXI will be published on the 1st of January, 1841. 




8 WORKS ON ANATOMY, SURGERY, MIDWIFERY, ETC. 



AN ATLAS OF PLATES, ILLUSTRATIVE OE THE 

PRINCIPLES AND PRACTICE OF OBSTETRIC MEDICINE AND 
SURGERY ; with descriptive letter-press. No. X. just published, price 
Is. 6d., containing Six Engravings, and three sheets of letter-press. To be 
completed in Thirteen numbers. By Francis H. Ramsbotham, M.D., 
Physician to the Royal Maternity Charity, and Lecturer on Obstetric Medi- 
cine at the London Hospital, &c. The Plates are Engraved by Mr. Henry 
Adlard, from Drawings made expressly for this Work by Mr. Bagg. 

" There is so much in the practice of Midwifery which cannot be understood without pic- 
torial illustrations, that they become almost essential to the student ; but hitherto the expense 
has proved an impediment to their being employed so much as desirable. The work before 
us is decidedly the cheapest of the kind which has ever fallen under our notice. Six really 
good engravings and several wood- cuts, with two sheets of excellent letter-press, for 
eighteen-pence. The work has only to be known to make the demand for it very extensive." 
— Medical Gazette. 

" We strongly recommend this work ; it is a useful contribution to medical literature, and 
decidedly the cheapest work which has ever issued from the medical press of this country." 
— Lancet. 

" We can speak very favourably both of the letter-press and of the plates, and as a large 
sale can only remunerate the Publisher, we wish him that large sale which he deserves." — 
Dr. Johnson's Review. 

" We strongly recommend the work of Dr. Ramsbotham to all our obstetrical readers, 
especially to those who are entering upon practice ; it is not only one of the cheapest, 
but one of the most beautiful works in Midwifery."— British and Foreign Medical 
Review. 

" We feel much pleasure in recommending to the notice of the profession, one of the 
cheapest and most elegant productions of the medical press of the present day. Each number 
contains six well-executed and accurate engravings on steel, several very beautiful wood- cuts, 
for eighteen-pence. The text is written in a clear, concise, and simple style. We offer our 
most sincere wishes that the undertaking may enjoy all the success which it so well merits." — 
Dublin Medical Press. 

The unanimous testimony of the medical press to the unprecedented cheap- 
ness and merits of this work, has promoted that extensive sale upon which the 
Publisher calculated for the return of the great outlay necessary to its produc- 
tion. The regular appearance of the work, and the increased expense incurred 
for the engravings, may be taken as a guarantee that it will be completed in 
the style with which it was commenced : an extra sheet of letter-press is also 
given in each number. 



A COMPANION TO THE MEDICINE CHEST, 

AND COMPENDIUM OF DOMESTIC MEDICINE ; comprising plain 
directions for the employment of medicines, with their properties and doses ; 
and brief descriptions of the symptoms and treatment of diseases, and of the 
disorders incidental to infants and children : with a selection of the most 
efficacious prescriptions. Intended as a source of easy reference for Clergy- 
men, and for families residing at a distance from professional assistance. 
By John Savory, Member of the Society of Apothecaries, and Fellow of the 
Medico-Botanical Society of London. Second Edit., 12mo, cloth, price 5s. 

"This little work, divested as much as possible of technical and scientific phraseology, is 
intended for the use of travellers, and those humane characters who, residing at a distance 
from a duly qualified medical practitioner, devote a portion of their time to the relief and 
mitigation of the complicated misfortunes of disease and poverty among their poor neighbours. 
It is, however, earnestly recommended not to place too much confidence on books of domestic 
medicine, especially in such cases as are of a serious nature, but always to have recourse to 
the advice of an able physician as early as it can be obtained." — Extract from Preface. 




PUBLISHED BY MR. CHURCHILL. 



A PRACTICAL WORK ON THE DISEASES OE THE EYE 

AND THEIR TREATMENT, MEDICALLY, TOPICALLY, AND 
BY OPERATION. By Frederick Tyrrell, Senior Surgeon to the 
Royal London Ophthalmic Hospital, Surgeon to St. Thomas's Hospital, 
Professor of Anatomy and Surgery at the Royal College of Surgeons in 
London, &c. &c. 2 vols. 8vo, with coloured Plates, £1. 16s. 

" This work is written in a perspicuous style, and abounds in practical information ; we 
add our earnest recommendation to our readers, to procure and read through the two volumes, 
assuring them that they will be richly repaid for their trouble. A series of plates, illustrative 
of the various diseases, are given." — Dublin Journal of Medical Science. 



A DISCOURSE ON THE PHENOMENA OE SENSATION, 

AS CONNECTED WITH THE MENTAL, PHYSICAL AND IN- 
STINCTIVE FACULTIES OF MAN. By James Johnstone, M.D., 
Physician to the General Hospital, and Lecturer on Materia Medica and 
Therapeutics at the Royal School of Medicine, Birmingham. One 8vo vol. 
(in the press.) 



A PRACTICAL TREATISE ON THE FUNCTION AND 

DISEASES of the UNIMPREGNATED WOMB ; with a chapter on 
Leucorrhoea, Fluor Albus, or Weakness. By Charles Waller, M.D., 
Consulting Physician- Accoucheur to the London Midwifery Institution, 
Lecturer on Midwifery and Diseases of Women and Children, at the Medical 
School, Aldersgate Street. 1 vol. 8vo, cloth, illustrated by Plates, price 9s. 
(now ready.) 



THE TREATMENT OE SOME AEEECTIONS OE THE 

PROSTATE GLAND. By R. A. Stafford, Surgeon to the St. Mary- 
lebone Infirmary. 8vo, with plate, price 5s. 

" We have read Mr. Stafford's work with considerable interest : the great frequency of 
such diseases, their difficulty of management, their extreme inconvenience, render every 
attempt to improve their treatment worthy of encouragement, and entitle the practitioner 
who, with a view to such improvement, ventures out of the beaten road of practice, to our 
liberal consideration, our cordial thanks, and sincere gratulations on his success."— 
Medical Gazette. 



ANATOMICAL, PATHOLOGICAL AND THERAPEUTIC 

RESEARCHES ON THE YELLOW FEVER. By P. Ch. A. Louis, 
Physician to the Hotel Dieu. From observations taken by himself and 
M. Trousseau, as Members of the French Commission at Gibraltar. Trans- 
lated by G. C. Shattuck, M.D., Member of the Society for Medical Ob- 
servation at Paris. 8vo, cloth, 10s. 



CHURCHILL'S CATALOGUE OE MODERN MEDICAL 

WORKS, comprising Anatomy, Medicine, Surgery, Midwifery, Materia 
Medica, Pharmacy, Chemistry, Medical Jurisprudence, Botany, Veterinary 
Surgery, &c. &c. With their prices and dates, 12mo, Is. 




m 



10 



WORKS ON ANATOMY, SURGERY, MIDWIFERY, ETC. 



WORKS LATELY PUBLISHED. 





RESEARCHES ON THE DEVELOPMENT, STRUCTURE, 



AND DISEASES OF THE TEETH. By Alexander Nasmyth, F.L.S., 
F.G.S., and Fellow of the Royal Medical and Chirurgical Society. 8vo, cloth, 
plates, price 10s. 6d. 

" Such interesting and important discoveries have lately been made on the structure of 
the teeth, and so important have these organs become as guides to the anatomist in the 
classification of the different members of the animal kingdom, that a new work on the subject 
was imperatively called for, and the demand could not have been more efficiently responded 
to than it is by Mr. Nasmyth in the work before us." — Lancet. 

" Here we terminate our notice of this interesting and important volume, strongly recom- 
mending it to the attention of all who are interested in the scientific investigation connected 
with our profession." — Medical Gazette. 

" The work of Mr. Nasmyth contains an entire translation of the papers of Retzius, 
illustrated by many beautiful and original plates ; also, a complete view of the researches of 
those whose names we have introduced in the present article ; and, lastly, a comprehensive 
historical survey of all works on odontology."— British and Foreign Medical Review. 

" We shall but try to convey such an idea of the value of Mr. Nasmyth's work as may 
excite the desire to study it with the attention it deserves. It is illustrated by seven most 
beautifully executed steel engravings."— Dublin Medical Press. 



THE MODERN TREATMENT OE SYPHILITIC DISEASES 



both Primary and Secondary ; comprehending an Account of improved 
Modes of Practice adopted in the British and Foreign Hospitals, with 
numerous Formulae for the Administration of many new remedies. By 
Langston Parker, Professor of Anatomy and Physiology in the Bir- 
mingham Royal School of Medicine. 12mo, cloth, price 5s. 
" An excellent little work ; it gives a clear and sufficiently full account of the opinions and 
practice of M. Ricord, Desrulles, Cullerier, Wallace, &c. Such a digest cannot fail to be 
highly useful and valuable to the practitioner." — Dublin Medical Press. 

" This little work is a useful compendium of the practice of the French surgeons. The 
book is judicious and well timed, and will save many practitioners from the erroneous dulness 
of routine." — Medical Gazette. 

"This manual, we doubt not, will be extensively read: we recommend our readers to 
procure the book, it is not a large one, and a perusal will afford much information." — 
Dublin Medical Journal. 



PRINCIPLES OF GENERAL AND COMPARATIVE PHY- 



SIOLOGY, intended as an Introduction to the Study of Human Physiology, 
and as a Guide to the philosophical pursuit of Natural History. By Wm. 
B. Carpenter, M.D. 8vo, with 240 figures on Copper and Wood, price 15s. 

" No treatise on physiology which has hitherto appeared in our language exceeds the 
present, either in the comprehensiveness of its principles, or in the value and abundance of 
its facts. We recommend it to all our readers, and to men of science of every description.'' — 
British and Foreign Medical Review. 

" In Dr. Carpenter's work lately published, will be found the best exposition we possess 
of all that is furnished by comparative anatomy to our knowledge of the nervous system, as 
well as to the more general principles of life and organization." — Dr. Holland's Medical 
Notes. 

" This is an admirable work, and will give Dr. Carpenter a high rank among the cultivators 
of natural philosophy. We strongly recommend it to all who have leisure for the delightful 
subject of which it treats."— Medical Gazette. 




m 



PUBLISHED BY MR. CHURCHILL. 



11 



A TREATISE ON THE NATURE AND TREATMENT OF 

HOOPING-COUGH, and its COMPLICATIONS ; illustrated by Cases, 
with an Appendix, containing Hints on the Management of Children, with 
a view to render them less susceptible of this and other Diseases of Child- 
hood, in an aggravated Form. By George Hamilton Roe, M. D., Fellow 
of the Royal College of Physicians, and Physician to the Westminster 
Hospital. Octavo, cloth, price 8 s. 



A MANUAL OE BRITISH BOTANY ; in which the Orders and 
Genera are arranged and described according to the Natural System of De- 
Candolle ; with a Series of Analytical Tables for the assistance of the 
Student in the Examination of the Plants indigenous to, or commonly culti- 
vated in, Great Britain. By D. C. Macreight, M. D., Lecturer on Materia 
Medica and Therapeutics at the Middlesex Hospital. Small 8vo, cloth, 7s. 6d. 

" There is a prodigious mass of elementary matter and useful information in this Pocket 
Volume." — Medico-Chirurgical Review, July, 1838. 

"This very elegant little volume is a most useful accession to Botanical Literature." — 
Literary Gazette. 



A TREATISE ON DISEASES OE THE SKIN. By p. rayer, 

D.M.P. Translated from the French, by William B. Dickenson, Esq., 
M.R.C.S. 8vo, price 12s. 
"We can recommend the present translation of Rayer's Treatise as an excellent companion 
at the bedside of the patient." — Lancet. 

" The translation of Rayer has conferred a great obligation on the science of medicine in 
England." — Medical and Surgical Journal. 



THE FIRST LINES OF THE PRACTICE OF SURGERY; 

designed as an Introduction for Students, and a concise Book of Reference 
for Practitioners. By Samuel Cooper, Professor of Surgery in the Univer- 
sity of London. Sixth Edition, carefully corrected, and considerably 
improved. 8vo, price 18s. 

By the same Author. 

A DICTIONARY OE PRACTICAL SURGERY; comprehending 

all the most interesting improvements, from the earliest times down to the 
present period, &c. &c. Seventh Edition. One very thick 8vo. vol. £1. 10s. 



THE MODERN PRACTICE OE PHYSIC; exhibiting the 

Characters, Causes, Symptoms, Prognostics, Morbid Appearances, and im- 
proved Method of treating the Diseases of all Climates. By Robert Thomas, 
M.D. Tenth Edition. 8vo, 18s. 



A SUPPLEMENT TO THE PHARMACOPOEIA ; being a 

Treatise on Pharmacology in general : including not only the Drugs and 
Compounds which are used by Practitioners in Medicine, but also most of 
those which are used in the Chemical Arts, or which undergo Chemical Pre- 
parations. Sixth Edition. 8vo, 14s. 




12 



WORKS ON ANA TOM Y 3 SURGERY, MIDWIFERY, ETC. 



A SYNOPSIS OF THE YARIOUS KINDS OF DIFFICULT 

PARTURITION, with Practical Remarks on the Management of Labours. 
By Samuel Merriman, M.D., F.L.S. Fifth Edition, with additions, 8vo, 
Plates, price 12s. 

" The merits of this work are already too well-known, and too highly appreciated by the 
profession, to require that we should express, at any great length, the high opinion we 
entertain of what is universally regarded as one of the very best practical books of reference 
in our language." — Dublin Medical Journal. 



THE EYE : a Treatise on the Art of Preserving this Organ in a Healthy 
Condition, and of Improving the Sight ; to which is prefixed, A VIEW OF 
THE ANATOMY AND PHYSIOLOGY OF THE EYE. By J. C. 
August Franz, M.D. With Plates, post 8vo, price 7s. 6d. 



FOR MEDXCAXi MB SUR.GXCAX. EXAMINATION. 

BY JOHN STEGGALL, M.D., 

LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS. 

A MANUAL FOR THE USE OF STUDENTS PREPARING 

FOR EXAMINATION AT APOTHECARIES' HALL. Ninth Edition. 
12mo cloth, 8s. 6d. 

II. 

A MANUAL FOR THE COLLEGE OF SURGEONS; 

intended for the use of Candidates for Examination, and Practitioners. By 
John Steggall, M.D., and M. W. Hilles, Surgeon. One thick volume, 
12mo cloth, price 12s. 6d. 

in. 

GREGORY'S CONSPECTUS MEDICINE THEORETICS. 

The First Part, containing the Original Text, with an Ordo Verborum and 
Literal Translation. Price 10s. 

THE FIRST FOUR BOOKS OF CELSUS. containing the 

Text, Ordo Verborum, and Translation. Price 8 s. 
The above two works comprise the entire Latin Classics required for Exami- 
nation at Apothecaries' Hall. 

v. 

A new, correct, and complete edition of 

CELSUS DE RE MEDICA, E RECENSIONE LEONARDI 

TARGiE. Price 7s. 

VI. 

THE DECOMPOSITIONS OF THE NEW LONDON 

PHARMACOPOEIA ; with Observations on the most active preparations. 
Price 3s. 

VII. 

THE ELEMENTS OF BOTANY. Designed for the Use of 
Medical Students. With Nine Coloured Plates. Price 6s. 



PUBLISHED BY MR. CHURCHILL. 



13 



THE PHYSICIAN'S YADE MECUM; OR, MANUAL OF 

THE PRINCIPLES AND PRACTICE OF PHYSIC ; containing the 
Symptoms, Causes, Diagnosis, Prognosis, and Treatment of Diseases, &c. 
New Edition, considerably enlarged, edited by Dr. Ryan. 7s. 6d. boards. 



A TREATISE ON THE DISEASES OF CHILDREN: 

With Directions for the Management of Infants from the Birth. By the 
late Michael Underwood, M.D. Ninth Edition, revised by Samuel 
Merriman, M.D., F.L.S., and Marshall Hall, M.D., F.R.S. 8vo, 
boards, 15 s. 



BILLARD'S TREATISE ON THE DISEASES OF 

INFANTS ; founded on recent Clinical Observations and Investigations in 
Pathological Anatomy, made at the "Hospice des Enfans Trouves," at 
Paris, under the superintendence of M. Baron, with a Medico-Legal Disser- 
tation on the Viability of the Child. With Notes, by Dr. Ollivier of 
Angers. Translated from the Third French Edition, with Notes, by James 
Stewart, M.D., Late Physician to the New York Orphan Asylum, and 
one of the Consulting Physicians of the Northern Dispensary of the City of 
New York. In one large 8vo volume, price 14s. cloth. 

" This translation of Dr. Billard's work will supply a want felt to exist in our medical 
literature. The author has enjoyed opportunities of pursuing pathological investigations to 
an almost unlimited extent, and, as the result, he has presented to the world a book 
remarkable for the variety and importance of the facts it contains. Of the manner in which 
Dr. Stewart has executed his task, we can speak in the highest terms."— Dr. Johnson's 
Review, April, 1840. 

*„.* The Author's opportunity for pursuing the necessary investigation of the 
various subjects treated of in this work may be learned from the circumstance 
of his occupying a station in the " Hospice des Enfans Trouves," which enabled 
him, in one year alone, to examine the condition of 5300 infants, and to extend 
his anatomical researches to nearly 700. 



ELEMENTS OF NATURAL PHILOSOPHY; being an Ex P e- 

rimental Introduction to the Study of the Physical Sciences. Illustrated 
with Two Hundred and Thirty Wood-cuts. 8vo, price 12s. cloth. By 
Golding Bird, M.D., F.L.S., F.G.S., Lecturer on Natural Philosophy at 
Guy's Hospital. 

" By the appearance of Dr. Bird's work, the student has now all that he can desire, in one 
neat, concise, and well-digested volume. The elements of natural philosophy are explained 
in very simple language, and illustrated by numerous woodcuts." — Medical Gazette. 

" This work teaches us the elements of the entire circle of natural philosophy in the 
clearest and most perspicuous manner. Light, Magnetism, Dynamics, Meteorology, Elec- 
tricity, &c, are set before us in such simple forms, and so forcible a way, that we cannot 
help understanding their laws, their operation, and the remarkable phenomena by which 
they are accompanied or signified. As a volume of useful and beautiful instruction for the 
young, and as a work of general value to both sexes, we cordially recommend it." — Literary 
Gazette. 

" This work marks an advance which has long been wanting in our system of instruction. 
Dr. Bird has succeeded in producing an elementary work of great merit, which may be pro- 
fitably used, not only by the medical, but by the general student." — Athenaeum. 



14 WORKS ON ANATOMY, SURGERY, MIDWIFERY, ETC. 



A TREATISE ON THE DISEASES OF THE HEART 

AND GREAT VESSELS, and on the Affections which may be mistaken 
for them. By J. Hope, M.D., F.R.S., Physician to St. George's Hospital. 
Third Edition. One thick 8vo volume, with plates, price 18s. 

" The addition of one-third of new matter to the present volume, and the care with which 
the whole has been revised and corrected, will, I trust, sufficiently prove my respect for the 
favourable opinion of my professional brethren, as evinced, not in this country only, but also 
on the European and American continents, by the sale of no less than six or seven editions 
and translations in as many years."— Extract from Preface. 



OUTLINES OE HUMAN PHYSIOLOGY. 

Fourth Edition, with Numerous Engravings on Wood. By Herbert Mayo, 
F.R.S., Surgeon to the Middlesex Hospital. 8v0, cloth, 18s. 



THE SURGEON'S YADE MECUM; A HANDBOOK OE 

. THE PRINCIPLES AND PRACTICE OF SURGERY; iUustrated 
with numerous Wood Engravings. By Robert Druitt, M.R.C.S. Fcap. 
8vo» cloth, price 8s* 6d. 



INTERMARRIAGE ; or, the Mode in which, and the Causes why, 
Beauty, Health, and Intellect, result from certain Unions, and Deformity, 
Disease, and Insanity from others ; demonstrated by Delineations of the 
Structure and Forms, and Descriptions of the Functions and Capacities, 
which each Parent, in every Pair, bestows on Children, in conformity with 
certain Natural Laws, and by an account of Corresponding Effects in the 
Breeding of Animals. Illustrated by Drawings of Parents and Progeny. 
By Alexander Waxker. Octavo with Plates, price 14s. cloth. 



A CLINICAL TREATISE ON THE ENDEMIC EEYERS 

OF THE WEST INDIES, intended as a Guide for the Young Practitioner 
in those Countries. By W. J. Evans, M.D. Octavo, cloth, price 9s. 

" We strongly recommend this work to every medical man who leaves the shores of England 
for the West India Islands ■. It is full of instruction for that class of the profession, and indeed 
contains a great mass of materials that are interesting to the pathologist and practitioner of 
this country." — Medico-Chirurgical Review. 



A MANUAL OE PRACTICAL MIDWIFERY, containing a 

Description of Natural and Difficult Labours, with their Management. In- 
tended chiefly as a book of reference for Students and Medical Practitioners. 
By James Reid, M.D., Lecturer on Midwifery at the Webb Street Medical 
School. 5s. 6d. With Engravings. 

"The relative diameters of the pelvis and the foetal head, and the different presentations 
of the child, are all usefully represented by wood engravings among the letter-press, 
and the book is thus particularly well calculated to effect the objects of such a work."— 
Lancet. 




PUBLISHED BY MR. CHURCHILL. 



15 



ELEMENTS OF THE THEORY AND PRACTICE OE 

MEDICINE ; designed for the use of Students. By George Gregory, 
M.D., Physician to the Fever Hospital. Fifth Edition, cloth, price 16s. 



THE MORBID ANATOMY OF THE HUMAN EYE. 

By James Wardrop, Esq., Surgeon to his late Majesty George IV. Second 
Edition, illustrated with Eighteen coloured Plates. 2 vols, royal 8vo. 
Price 30s. 

" The republication of a work which no subsequent production on ophthalmology has 
equalled, and which the whole existent range of works cannot supplant." — Lancet. 

The price has heen considerably reduced from the former Edition, but the 
same regard has been paid to the fidelity and beauty of the colouring of the 
Plates. 



MEDICAL BIBLIOGRAPHY. BY JAMES ATKINSON, 

Senior Surgeon to the York County Hospital, and late Vice-President of the 
Yorkshire Philosophical Society. Vol. L royal 8vo. 16s. 
" We have never encountered so singular and remarkable a book. It unites the German 
research of a Plouquet with the ravings of Rabelais, — the humour of Sterne with the satire 
of Democritus,— the learning of Burton with the wit of Pindar." — Dr. Johnson's Review. 



A PRACTICAL FORMULARY OF HOSPITALS, BRITISH 

AND FOREIGN ; including all the Medicines in use. By Michael Ryan, 
M.D., Member of the Royal College of Physicians. The Third Edition, 
considerably Enlarged and Improved. 5s. 6d. cloth. 

By the same author, 

THE MEDICO-CHIRURGICAL PHARMACOPEIA; 

OR A CONSPECTUS OF THE BEST PRESCRIPTIONS. Containing 
an account of all New Medicines, Doses, &c. ; Magendie's and Lugol's For- 
mularies ; the Improvements in the London Pharmacopoeia. New Nomen- 
clature ; the Treatment of Poisoning, Dislocations) Fractures, and Natural 
and Difficult Parturition. 3s. 6d. cloth. 
" A vast mass of information in this little work, all Useful at the bedside of sickness, or in 
the short hour of leisure from professional toils and anxieties."— Dr. Johnson's Review. 



NOTES ON THE MEDICAL HISTORY & STATISTICS 

OF THE BRITISH LEGION OF SPAIN; comprising the results of 
Gun-shot Wounds, in relation to important questions in Surgery. By 
Rutherford Alcock, K.T.S., Deputy Inspector General of Hospitals, &c. 
Octavo, price 5 s. 

PRACTICAL OBSERVATIONS ON THE PRESERVATION 

OF HEALTH AND THE PREVENTION OF DISEASES ; compris- 
ing the Author's experience on the Disorders of Childhood and Old Age. 
By Sir Anthony Carlisle, F.R.S., late President of the Royal College of 
Surgeons, and Senior Surgeon to the Westminster Hospital. 8vo, cloth, 8s. 



n * - — — 

16 WORKS ON ANATOMY, SURGERY, MIDWIFERY, ETC. 



A TREATISE ON RUPTURES. BY W. LAWRENCE, 

F.R.S., Surgeon to St. Bartholomew's Hospital. The Fifth Edition, consi- 
derably enlarged. 8vo, cloth, 16s. 

" The peculiar advantage of the treatise of Mr. Lawrence is, that he explains his views on 
the anatomy of hernia and the different varieties of the disease in a manner which renders his 
book peculiarly useful to the student. It must be superfluous to express our opinion of its 
value to the surgical practitioner. As a treatise on hernia, presenting a complete view of the 
literature of the subject, it stands in the first rank ; and for the surgeon, who does not make 
it his incessant and intimate study, it must be impossible either to think correctly or to act 
with judgment and decision in those cases, always difficult and complex, in which it becomes 
requisite to operate on a strangulated intestinal tumour." — Edinburgh Medical and 
Surgical Journal. 



PRINCIPLES OF MILITARY SURGERY ; comprising Obser- 
vations on the Arrangement, Police, and Practice of Hospitals ; and on the 
History, Treatment, and Anomalies of Variola and Syphilis. Illustrated 
with Cases and Dissections. By John Hennen, M.D., F.R.S., Inspector of 
Military Hospitals. Third Edition, with Life of the Author, by his Son, 
Dr. John Hennen. 8vo, boards, 16s, 

" The value of Dr. Hennen's work is too well appreciated to need any praise of ours. We 
are only required, then, to bring the third edition before the notice of our readers ; and having 
done this, we shall merely add, that the volume merits a place in every library, and that no 
military surgeon ought to be without it."— Medical Gazette. 



MEDICAL BOTANY; OR, ILLUSTRATIONS & DESCRIP- 
TIONS OF THE MEDICINAL PLANTS of the London, Edinburgh, 
and Dublin Pharmacopoeias ; comprising a popular and scientific account of 
poisonous vegetables, indigenous to Great Britain. By John Stephenson, 
M.D., and James Morss Churchill, F.L.S. New edition, edited by 
Gilbert Burnett, F.L.S., &c, Professor of Botany in King's College, 
London. In three handsome royal 8vo volumes, illustrated by Two hundred 
Engravings, beautifully drawn and coloured from nature, price Six Guineas, 
cloth lettered. 

" So high is our opinion of this work, that we recommend every student at college, and 
every surgeon who goes abroad, to have a copy, as one of the essential constituents of his 
library." — Dr. Johnson's Medico-Chirurgical Review, No. 41. 

" The price is amazingly moderate, and the work deserving of every encouragement." — 
Medical Gazette. 

" The authors of medical botany have amply redeemed the pledge which their first number 
imposed on them. The work forms a complete and valuable system of Toxicology and Materia 
Medica. It will prove a valuable addition to the libraries of medical practitioners and general 
readers." — Lancet. 

, ".The figures are equal, if not superior, to those of any other botanical periodical."— 
Louden'.-* Gardener's Magazine. 

UNIFORM WITH THE ABOVE WORK, 

MEDICAL ZOOLOGY AND MINERALOGY; OR, ILLUS- 

TRATIONS AND DESCRIPTIONS OF THE ANIMALS AND 
MINERALS EMPLOYED IN MEDICINE, and of the Preparations 
derived from them ; including a Popular and Scientific Account of Animal, 
Mineral, Atmospheric, and Gaseous Poisons. By John Stephenson, 
M.D., F.L.S. Forty-five Coloured Plates ; royal 8vo, cloth, £2. 2s. 



T. C. Savill, Printer, 107, St. Martin's Lane. 



PRACTICAL TREATISE 



ON THE 



BILIOUS REMITTENT FEVER; 



WITH ILLUSTRATIVE TABLES AND CASES, 
ON THE TEMPERATURE OF THE SYSTEM IN THE FEBRILE 
DISEASES OF JAMAICA. 

TO WHICH IS ADDED, 

MEDICAL TOPOGRAPHY OF THE DIFFERENT MILITARY 
STATIONS IN THAT IMPORTANT COLONY. 



FELLOW OP THE ROYAL COLLEGE OF PHYSICIANS, 
MEMBER OP THE WERNERIAN SOCIETY, EDINBURGH, &C. &C. 



LONDON : 

JOHN CHURCHILL, PRINCES STREET, SOHO. 



ITS CAUSES AND EFFECTS. 



BY W. ARNOLD, M. D. 




MDCCCXL. 



/ 




PRINTED 



LONDON I 

BY IBOTSON AND 
SAVOY STREET. 



VALMER 



TO 

SIR JAMES M'GRIGOR, BART. 

DIRECTOR-GENERAL OF THE ARMY MEDICAL DEPARTMENT, 
&C. &C. &C. 



Sir, 

Conscious as I am of the solicitude you have ever evinced for 
the health of her Majesty's land-forces in every part of the 
kingdom, but more particularly in the East and West Indies, I 
am gratified in being permitted to prefix your name to a work 
which has for its chief object the laudable attempt to preserve 
the lives of that force which achieved for England a peace of 
twenty-five years. 

The very flattering manner in which you have been pleased 
to express your opinion of my endeavours, is not to me more gra- 
tifying than is the honour which I confer on myself by in- 
scribing this volume to so respectable a name — a name 
associated with every benefit which has been obtained for the 
men&bers of that department which is placed under your 
guidance ; and with much sincerity I subscribe myself 

Your faithful and obliged Servant, 

W. ARNOLD, M.D., 

Fellow of the Royal College of Physicians, 
Member of the Wernerian Society, 
Edinb. &c. &c. &c. 



PREFACE. 



The following observations comprise a period of twenty- 
five years, the accuracy of which may be relied upon, both 
as regards the medical and philosophical remarks, of the 
vicissitudes of the seasons, the prevailing diseases in each 
year, and the peculiar character of the several epidemics 
during the period. 

A brief analysis of each year's observations will serve to 
explain the changes of the seasons, and how far the dis- 
eases are influenced by those changes. 

Close personal observation for so many years of the 
various phenomena connected with the diseases of a tro- 
pical country could not fail to present to an inquiring 
mind a rich mine of materials ; and, in offering the result to 
an enlightened public, I only claim the merit of being 
actuated by the laudable desire to preserve the lives of 
my fellow-creatures in a climate which has acquired the 
name of being exceedingly hostile to the health of Euro- 
peans. 

I commenced the task unassisted, and without reference 
to any author ; for I cavil not with the opinions of others. 



Vi 



PREFACE. 



I desired only to satisfy my own mind correctly of the 
nature and causes of the diseases incidental to Euro- 
peans, as well as of the nature and causes of the indi- 
genous fever, the great scourge of life of Jamaica. I 
was not a little perplexed, in my early career, to witness 
amongst practitioners such a discrepancy of opinion rela- 
tive to the treatment of this formidable enemy of mankind, 
each party advocating doctrines diametrically opposite. 
One party assailed the foe with the lancet indiscrimi- 
nately. The other party with more subtilty attacked the 
citadel with poison, and gave their favourite mercury 
with prodigal liberality. 

Surrounded by no common order of difficulties, when 
men of long standing and ability marshalled such forces to 
the fight — unable as I was at that time to say who was 
right — I determined to act with caution, to make nature 
my guide, to watch her works in all and every way, to 
separate cause from effect ; and whilst reasoning thus, I 
sought to uplift the veil which screened the truth from my 
view. 

I accordingly adopted the plan of keeping a diurnal 
registry, in which I recorded the changes in the tem- 
perature of the weather ; the peculiarities of the diseases 
witnessed and treated, whether assailing the European, 
the various castes of Creoles, or the black inhabitants ; 
and I sought also to inquire how far the changes in the 
temperature of the atmosphere had influence over the 
diseases, and if the changes observed in the diseases 
could be ascribed to such changes. 

The preliminary experiments on the temperature of the 
system were instituted for the purpose of ascertaining the 



PREFACE. 



vii 



exact temperature of every class of residents in the island, 
in a state of health, and under the various circumstances 
which are mentioned. 

The cases on temperature of the system in the febrile dis- 
eases will then follow; for I have considered this symptom to 
be one of the most formidable with which we have to combat 
in the treatment of the bilious remittent fever, no matter 
where we may meet it : believing, as I do, that the system 
when labouring under this disease must inevitably give 
way to the cause which produces even a few degrees of 
thermal exaltation beyond 105° of Fahrenheit's scale, and 
that all our remedies will have little effect if we find it 
110° during the first or the second stages. 

I may here remark, the greater number of cases given 
in illustration of this fact, in the course of the work, were 
males, for the most part patients treated in the military 
hospital under my charge, at different periods, for a great 
many years. 

I must also claim the medical reader's attention to the 
remarks relative to the treatment of females when assailed 
with this disease in civil life, as being in every respect 
essentially different in every stage. 

The concluding aphorisms will enable the reader to 
form a just estimate of the admonitions on this head. 

The medical topography, it is hoped, will not be found 
the least interesting portion of the work. 



INTRODUCTION. 



The Author fully intended to have given a brief analytical 
review of the opinions entertained in these reports regard- 
ing, in many instances, the causes of the fever in the naval 
squadron on the West Indian station, but he has been dis- 
appointed in receiving some documents, which, in the 
hurry of leaving Jamaica, were left behind. 

The very able manner in which the army statistical 
reports have been drawn up by Major Tulloch reflect the 
greatest credit upon his talent and perseverance ; and it is 
extremely gratifying that the Author has it in his power to 
acknowledge the correctness of the remarks in most in- 
stances. The topographical accounts, in a few of the 
military stations, are somewhat incorrect, as will be seen 
by a reference to the diagrams in this book, but these in- 
accuracies are not very important ; taken as a whole, they 
may be considered as the only authentic records which 
have ever been submitted to the public. 

The Author also acknowledges with much pleasure the 
information he has derived from the Statistical Reports of 
the Navy, as compiled by Dr. Wilson. Those which have 
been inserted in the Appendix are unquestionably valuable 
and ably drawn documents. Almost all the facts embodied 



X 



INTRODUCTION. 



therein, the iVuthor, for the most part, is cognizant of; 
and he would have been enabled, but for the disappoint- 
ment above alluded to, to have answered in a satisfactory 
manner the questions so pertinently asked at page 295. 
££ What is the reason why an epidemic, having been ex- 
tinguished, re-appears first in solitary and detached in- 
stances, then more frequently in closer connexion, gather- 
ing strength as it proceeds, and finally explodes with the 
renewed power of a sweeping epidemic, again to be 
extinguished, and again to be renewed ? What is the 
meaning of this progress ?" 

It is much to be regretted that, in the Reports of Dr. 
Wilson, a variety of names have been assigned to the 
endemic fever of the West Indies ; some of the medical 
officers calling it remittent, others yellow, and others in- 
flammatory. Dr. Wilson very properly observes, " Soon 
after anchoring there, both vessels were attacked by a 
fever, which one surgeon calls yellow, and the other re- 
mittent fever." 

" It is not known whether the same fever was meant to 
be expressed by the two names, but the disease was clearly 
the same in both vessels, the same as that which had been 
prevalent on the island during great part of the year, avid 
probably identical with that in the Skipjack ; whether it 
was the same as that which had been so rife in the Tweed, 
is less obvious" 

Regarding the sickness on board the Vestal, the cause 
was evidently epidemical influence. It will be seen that I 
have mentioned, in another part of this work, the circum- 
stance of the removal of this ship from Port Royal Har- 
bour to one of the sandy keys, about a mile or more from 
the port. The epidemic here alluded to appeared very 
early in the year. 



INTRODUCTION. 



xi 



" Another circumstance ought to be stated, not for its 
rarity, but for its frequency, and its importance in con- 
sidering the cause of this disease, more especially in ships. 
It is this : almost every person who joined the Vestal 
during the prevalence of fever was attacked by it ; and so 
it happens, if not universally, almost universally. Nearly 
every man who joins a ship in such a condition has the 
prevalent disease sooner or later ; but no number of per- 
sons taken from such a ship, labouring under the disease 
in any stage, or in any force, and placed in a situation 
where the disease does not exist, though in the centre of a 
mass of healthy people, can excite it in a single instance." 
An accumulation of such facts — and there is a large accu- 
mulation—decides the question of the contagious power of 
the fever in the negative, absolutely. Dr. Wilson again 
asks a question — " To what, then, in a case like this, is it 
to be ascribed, not only primarily, but secondarily, as well 
during its progress as at its commencement ? Probably 
it would be difficult to settle this question ; but a great 
deal of the difficulty vanishes when we bring to the sup- 
port of our argument other causes besides the morbific 
atmosphere, and the chemical changes effected in the 
structural materials of the vessel. 

As soon, however, as I am able, after the receipt of the 
documents alluded to, these questions will be considered, 
and the result of the opinions which will be given in sup- 
port of the views the Author entertains on these important 
points will be published, so as to be appended to, and 
which will be delivered gratuitously to all those who may- 
be in possession of this work. 

The Author trusts this will be considered a sufficient 
apology to his readers. 



A PRACTICAL TREATISE, &c. 



Under the name of yellow fever are comprehended a great 
variety of diseases mentioned by authors. 

Synonima. — Typhus ieterodes de sauvages ; continua pu- 
trida ieterodes Carolinenses of Macbride. Elodes ietero- 
des. — Vogel. Febris maligna biliosa America?. — Moultrie. 
Febris gastrico-nervosa. — Franck. Synochus icterodus. 
— Cullen. Fievre matelotes de la Labat. Febris ma- 
ligna flava Indicge Occidentalis. — Warren. Casus tropi- 
cus endemicus. — Moseley. Bilious remittent yellow fever. 
— Chisholm. Fievre jaune d'Amerique. — Valentin. Fievre 
gastro-adynamique. — Pin el. Febris-typhus miasmatique 
atacique putride jaune. — M. Bally. Vomito prieto, 
vomito negro l'Amerique-Espagnole. Mai de Siam des 
anciens historiens des Antilles fievre jaune. This enu- 
meration, and many others, are the various synonima of this 
interesting fever. 

Will it not evidently appear that either different names 
are given to the same disease, or that different diseases are 
comprehended under these different names ? 

B 



2 



BILIOUS REMITTENT FEVER. 



The ancients handed down to us this error, which 
appears to be continued with scrupulous nicety to the 
present day, not only in the varieties of diseases, but 
others. Cullen, in speaking of pneumonia, evidently 
thought pneumonia and pleuritis to be one disease. The 
ancients made two genera of the inflammation of the 
thorax. 

Cullen, however, remarks, with his characteristic can- 
dour, "That it is improper to give different names to 
diseases which diner only in degree ; but it has been cus- 
tomary of late for physicians to denominate a certain 
fever, as if different from others, a nervous fever. I have 
in some measure in compliance with this practice, under 
the title Typhus mitior, enumerated those fevers of various 
authors which could be referred to the nervous fevers of 
the moderns ; though, perhaps, not with much accuracy, 
as the limits are by no means settled." 

" I am still inclined, either with ancients or moderns, to 
class among the genera of fevers anything under the 
name of putrid fever. I conceive that in every species of 
typhus there is a tendency in the humours to putrefac- 
tion ; and the species may be varied by the degree of pu- 
tridity, but cannot be altered. ,, 

OPINIONS OF AUTHORS. 

Writers of great authority in medicine assign to en- 
demic fevers a cause by which the vital power is directly 
injured. The opinion of the celebrated Stholl is hardly 
different : — " The proximate cause of those fevers be- 
longs to the nervous system, affected in a manner which 
we hitherto cannot explain. 

Senac says, it is impossible to establish, in a matter 



BILIOUS REMITTENT FEVER. 



3 



of such obscurity, what is precisely the proximate cause ; 
it appears alone certain, that something adequate to excite 
the fever is introduced into, or developed in, the body. 

These fevers prevailing in certain seasons, they also 
prevail in certain places, and more particularly in marshy 
countries. 

Humboldt and Ingenhouz say that experience teaches 
us that the atmospheric air which does not possess a suffi- 
cient quantity of oxygen, or which is surcharged with 
azote, is hurtful to those who respire it, and that it is 
capable of engendering very malignant nervous fevers ; 
that a similar state must be that of the atmosphere in 
marshy countries ; that the cause of the fevers, particu- 
larly of marshes, is in its nature sedative and debilitating. 

Sauvages, Linne, and Sagar, made a separate order of 
remittent fevers, as if they were totally different from in- 
termittents, as they are called, but in my opinion im- 
properly. 

Cullen says : — " I acknowledge no sufficient cause of 
intermittent fevers but marsh miasmata ; but as this mi- 
asma is not always strong enough to produce the dis- 
ease without the concurrence of other exciting powers, 
I here admit these powers part of the cause, although 
they would not have produced the disease, had not the 
miasma been previously applied." 

Brendelius says, all fevers, whether acute, inflammatory, 
eruptive, putrid, or otherwise, are continued remittents, 
and fill up their periods of intentions and remissions. 

Pringle and others observe, that the two great exciting 
causes of fever are human and marsh effluvia, while the 
predisposing are almost innumerable. The more prominent 
are, plethora, inanition from excessive evacuations, the 
depressing passions, mental or corporeal exertions, ex- 

b 2 



4 



BILIOUS REMITTENT FEVER. 



tremes of atmospheric heat and cold, especially alterna- 
tions of these or of heat and moisture ; sol-lunar influence. 

Remittent fever, says Henderson, is the legitimate off- 
spring of all hot climates, especially where marshes abound ; 
it is the autumnal disease of most parts of Europe. The 
cause of this fever in all its varieties is marsh effluvia ; 
nor can, in my opinion, any other cause produce it. 

Blane says, that the bilious remittent fever may gene- 
rally be traced to the air of woods and marshes, and in 
our fleet hardly any men were attacked with it but those 
who were employed in the duties of wooding and wa- 
tering. 

In my essay on preserving seamen, I have (says Lind) 
remarked that a malignant fever of the remitting kind, 
most frequently a double tertian, is the genuine produce 
of heat and moisture ; is the autumnal fever of all hot 
countries, and is the epidemic disease between the 
tropics ; to which T may add, that it is also the most 
fatal disease to Europeans in hot climates. 

The cause, in fact, says Chisholm, of typhus, is, I 
believe, an undefined change in the atmospheric air, 
brought on by its confinement in a very limited space, and 
incapacity, in a great degree, of removal, and the respira- 
tion of an effluvia emanating from persons inhabiting the 
close dwellings in which the fever is found. 

Hear what Fordyce has to say : " Of the number of 
causes to which fever has been ascribed by practitioners 
who have treated of this disease, few will bear the test of 
any strict inquiry." 

" If more proofs of the specific power of marsh miasmata 
to produce fever should be desired, they may be found in 
the treatise, " De noxiis paludum effluviis, eorumque 
remediis." — Bancroft. 



BILIOUS REMITTENT FEVER. 



5 



These are, comparatively speaking, but a small propor- 
tion to the numberless opinions entertained relative to the 
cause of this fever ; so great a discrepancy is somewhat 
difficult to reconcile, and at the present moment foreign 
to my purpose. 

HISTORY OF THE DISEASE. 

The yellow fever has long been endemic in the West 
India Islands and the neighbouring continents of South 
and North America. 

No particular description of this disease existing in the 
West Indies occurs in medical writers before the year 
1694. 

The tradition is, that it was imported into Martinico, 
a few years before, by a French ship which came from 
Siam, in the East Indies. 

Hence it long went under the name of maladie de Siam, 
or des matelots, because introduced by sailors ; but this 
account is very doubtful, for it is certain that on the dis- 
covery of the West Indies the new comers were earned off 
by severe fevers. — According to Humboldt. 

Carthagena,* which is one of the best built, the most 

* The harbour of Carthagena had formerly two entrances, called Boca 
Grande, and Boca Chica. In order to render the city more secure from 
foreign invasion, the Spaniards filled up the Boca Grande, which was con- 
siderably nearer to the city than the Boca Chica is. 

The latter is protected on the north side by a very formidable fortification, 
and on the south side by two other forts, one of which is built in the water. 

The city is protected by the Fort St. Lazarus, which is, in its tum, com- 
manded by the hill on which stands the Convent of Lapopa. 

The city is built at right angles, the streets very narrow, and at present 
are miserably dirty ; every description of filth is thrown into them, and there 
allowed to remain until washed away by the rain : notwithstanding all this, 
I am credibly informed it is much more healthy now than in former years. 



6 



BILIOUS REMITTENT FEVER. 



regular, and best disposed towns in the new world, has 
been frequented by severe visitations of sickness ; and in 
the account which I have seen, written about one hundred 
years since, it appears that a fever of a very malignant 
form, attended with delirium and vomiting, and but of 
short duration, devastated the town and environs, and 
every year a great number of persons died. This is not 
surprising, when it is considered what a strange homo- 
genous congregation of persons of all nations centered 
there. 

The climate, nearly insupportable, produces inactivity 
and indolence, — the heat excessive ten months in the 
year, — May and September forming exceptions, in con- 
sequence of torrents of rain which fall periodically in 
these months. 

Several histories of very malignant epidemic fevers are 
mentioned after this period, under the names of putrid, 
pestilential, &c. &c. And the black vomit, and the yel- 
lowness of the skin, are occasionally mentioned. 

This fever did not, however, attract the attention of 
physicians very much until the war which ended in 
1763; during which the mortality amongst the soldiers 
was dreadful. 

In the late revolutionary war its ravages were still more 
extensive, sweeping off whole battalions in a very short 
period ; and it seemed to have acquired a greater degree 
of virulence, for it cut off a greater number of the natives 
than formerly. 

It spread to the neighbouring continents of North and 
South America, and it even visited the southern parts of 
Europe, which it has frequently visited since : as at 
Cadiz, in the year 1819; at Malaga, 1803; Leghorn, 
1804; and Gibraltar, 1804, 1813, and 1828. Here it is 



BILIOUS REMITTENT FEVER. 



7 



unquestionably endemic, and in the years above men- 
tioned it was particularly fatal. 

It is said to have appeared at Marseilles, and at Brest ; 
and alarms have been excited at times to some of the sea- 
ports of Great Britain. 

SYMPTOMS. 

In a disease which occurs occasionally only, which is 
spread over so great an extent of the world, it cannot be 
supposed that the symptoms are uniform, and accordingly 
they have been variously mentioned by different authors. 
And it is probable that different diseases have often been 
described under the denomination of yellow fever. 

This may account for the many disagreements of 
physicians on this subject. But there seems to be a 
particular disease which may be designated by a certain 
train of symptoms. 

They have been divided into two or three stages, which 
are in some degree fanciful, because they cannot be pre- 
cisely limited ; but they may be adopted, as they give a 
greater precision to our ideas. 

To illustrate the true characteristic symptoms, I refer 
the reader to a detail of some very interesting cases ; and 
in order that he may be more conclusively satisfied, I 
have set forth the different periods of the year when the 
different constitutions, ages, and sexes were attacked. 

The first attack is very insidious,, although sudden : 
sometimes it comes on with all the precursors of fever, 
and it will have frequently advanced to the second stage 
before the new-comers will complain. Their muscular 
strength is diminished ; languor, gaping, and aversion to 
move, succeed ; sometimes attended by vertigo, or a severe 



8 



BILIOUS REMITTENT FEVER. 



headache and pain in the eyes. These symptoms are too 
often by the individual attributed to some little irregu- 
larity proceeding from the unbounded hospitality shown 
to strangers on their first arrival, and generally expected 
to be got the better of by rest. The next day the error of 
this delusion vanishes, and a more formidable train of 
symptoms supervenes. 

Sometimes the bowels are first affected, but in general 
violent headache, thirst, pains in the back, loins, and legs, 
succeed rigors, and mark the nature of the disease. I 
have known it ushered in by syncope and trembling, fol- 
lowed by a state bordering on stupor ; and it is to be par- 
ticularly remarked, that in such cases the greatest danger 
is to be feared. The countenance becomes marked by 
great dejection ; the eyes are dull, glassy, and suffused. 

The thirst is irregular ; the tongue is sometimes foul and 
dry, but in general its black appearance is not seen until 
the disease is more advanced ; it is more frequently of a 
red colour, particularly at the sides. 

The heat, which is greatly increased, produces anxiety, 
restlessness, and delirium of the low muttering kind, (at 
times so violent as to require the strait waistcoat,) but 
generally of the comatose description, particularly if it 
does not come on until the disease is more advanced. 

It has been said that the muscular strength is less 
diminished in this than in other fevers, so that persons 
afflicted with it have gone about their usual duties till 
within a short period of death. Of this I do not believe 
one word ; there is no disease wherein the muscular power 
is so much impaired from the commencement to the ter- 
mination, as it is in this ; particularly if the invasion is 
brought on by syncope. 

There is no precise limit to mark the first stage of this 



BILIOUS REMITTENT FEVER. 



9 



disease ; it may be a day or two, sometimes only a few 
hours. 

SECOND STAGE. 

The second stage is often ushered in by a remission 
of the symptoms, and an apparent return to health. But 
this calm lasts only for a short time. An increase of the 
febrile symptoms succeeds, accompanied more or less with 
pain at the scrobiculus cordis — more or less with irritability 
of the stomach ; sometimes the vomiting will precede and 
sometimes succeed the rigors, headache, &c, of the first 
attack : oppression at the precordia is generally felt, and 
by most patients on the first attack. 

The matter ejected at times is slimy and tasteless — at 
others, of a dirty green colour at first, but it does not 
always become dark or black, except in very aggravated 
forms of this disease. And it is in these forms that the 
body, as well as the urine, exhales a very foetid odour. 

The skin assumes at times a deep yellow tinge, and it 
has been said to become nearly black. I have not, how- 
ever, seen such an appearance even when gangrene is 
indubitably existing in the system ; then, and then only, 
the skin becomes bluish. 

The yellow suffusion is not always present — indeed, in 
the greatest number of cases which I have seen, it did 
not exist at all ; and when it is witnessed, it is very un- 
certain at what time it comes on, varying from one, two, 
four, and five days, from the first attack. 

THIRD STAGE. 

The third stage, especially if the disease is to terminate 
fatally, is characterised by the great increase of all the 



10 



BILIOUS REMITTENT FEVER. 



symptoms, and in particular cases, where irritability of 
the stomach has prevailed, it will now scarcely retain 
anything. 

The matter which is thrown up assumes a black flaky 
colour, resembling coffee grounds. This is the well- 
known symptom denominated black vomiting, or the 
vomito prieto of the Spaniards. The ejections are tarry, 
often bloody, and blood sometimes issues from various 
outlets of the body. These haemorrhages are generally 
fatal. 

The whole body at this time exhales a peculiar foetid 
odour, the urine dark, scanty, and is often suppressed 
altogether. 

It is not at all uncommon to see a patient sit up, ask 
for food, attempt to shave himself, dress, and wish to quit 
the room ; a marked peculiarity in this disease, showing, as 
it were, a return of the mental faculties previous to 
death. 

The inguinal and parotid glands frequently swell and 
suppurate. 

Putrid black sordes line the mouth, and cover the teeth 
and lips. 

Death comes on with spasmodic convulsive collapse, or 
debilitated symptoms. 

This stage continues twenty-four or thirty hours, some- 
times only a few hours, collapse taking place when the 
patient may have left his bed for the night-chair, and he 
there droops his head and dies. 

When the disease is to terminate favourably, then all 
the symptoms disappear gradually; the skin, becoming 
moist, assumes its natural colour ; refreshing sleep ; and a 
total change takes place in the aspect of the features, the 
countenance mild, and the mind tranquil ; but sometimes 



BILIOUS REMITTENT FEVER. 



11 



the patients are peevish, fretful, and difficult to please. 
But great debility, especially of the digestive organs, 
remains for many days. 

Sometimes the symptoms go on uninterrupted ; at 
others, a real remission takes place. 

The type of this varies, but more generally it is quoti- 
dian. 

The duration of this disease is quite uncertain ; it would, 
indeed, be arrogating too much to fix any limited period 
from three to twenty days. 

I have seen many aggravated forms run on to the latter 
period, performing the course of exacerbation and remis- 
sion within the twenty-four hours, and yet 1 cannot pro- 
nounce these protracted cases less dangerous than those 
which terminate more suddenly. 

PROGNOSIS. 

Most authors who have ventured their opinions to the 
world relative to this disease are divided as to the 
exact nature of this dreadful malady, which has hurled so 
many thousands of our countrymen to a premature grave. 

I have scarcely met with two, in the whole course of 
my reading, whose ideas seem to correspond. Those 
who have bestowed most pains in their researches, and 
who appear most diligent in the collection of facts, are 
either silent, or furnish but little information on those 
points which demonstrate the true character of the dis- 
ease. 

Some of the symptoms and appearances are indeed de- 
tailed with much perspicuity, but they are so mixed up 
with vague remarks, that it is hard to sever the correct from 
the erroneous opinions entertained. 



12 



BILIOUS REMITTENT FEVER. 



It would appear, as the general inference, that Europeans 
are assailed with a number of febrile diseases in tropical 
countries, all essentially different in character. 

Many who have written, have written hastily, or at 
least have been biassed with the opinions of others, who 
in all probability have never seen the disease. 

Neither the order nor the duration of the different stages, 
the diagnostic or prognostic symptoms, show those un- 
erring signs which always present themselves in the dis- 
ease, commonly called the yellow or bilious remittent 
fever. 

This may have arisen in consequence of the fallacious 
nature of the symptoms, (in different individuals,) which 
are constantly intruding themselves on the attention of 
practitioners during the malady, sufficient to puzzle and 
perplex ; therefore, an author can neither be too minute in 
his detail, nor too particular in his description of every- 
thing which relates to the disease. 

The mind of a medical man unaccustomed to see such 
a disease should be unfettered by doubts, which cannot 
fail to embarrass and mislead him. For it is, alas ! when 
viewing the strange medley of symptoms, that the prac- 
titioner, without being able to upbraid himself for want of 
skill, oftentimes feels himself involved in uncertainty, and 
the mind, as it were, becomes paralyzed in a vortex of 
obscurity. 

For the preservation and future benefit of our fellow 
creatures, for the honour of those in the profession who 
embark in the wide field of experience in a foreign clime, 
let me arrest their attention to a candid relation of facts, 
collected at the bedside of many hundred patients, the 
result of many years of careful investigation. 

I feel persuaded that almost every young practitioner 



BILIOUS REMITTENT FEVER. 



13 



will err, unless he is more than ordinarily gifted, in form- 
ing his conclusions both as to predisposition and to the 
cause of the different febrile diseases felt in tropical cli- 
mates. He cannot be too cautious in determining, nor 
too prompt in advising when he has determined ; for he 
must ever hold in mind, that disease advances with giant 
strides in these countries, and with such Herculean force 
assails the frame, that the patient is frequently annihilated 
before any remedy can be made to act upon the already 
exhausted system. 

Age, sex, habits, temperament, climate, in fact the 
idiosyncrasy, must be constantly kept in view — he cannot, 
he must not pause long, or as he would be inclined to do 
in a cooler climate. 

Difficulties, neither contemplated nor foreseen, will daily 
stare him in the face, and unless he boldly reasons and 
thinks for himself firmly, and with unshaken confidence 
in the primary object — the laws of animal life in the 
healthy state — he had better abandon a pursuit, to say the 
best of it, surrounded with many intricate and disagree- 
able obstacles. If he does not abandon, let him study 
the nature of predisposition, and the kind of diathesis, 
w T hether sthenic or asthenic, to which it inclines. Garnet 
lays great stress upon these very important points. 

If a person by any means be deprived of the proper 
quantity of food, he will feel himself enfeebled, the func- 
tions will gradually grow more and more languid, and at 
last become irregular, and be performed with pain. Here 
is excitability enough, and even too much, for it has 
accumulated by the subtraction of a stimulus ; but here is 
a deficiency of excitement from defect of stimulus. Sup- 
pose a person in good health begins to take a greater 
quantity of food than usual, and adds an excess of wine, 



14 



BILIOUS REMITTENT FEVER. 



all the functions will at first be increased in vigour, but at 
last they will be irregularly performed, and inflammation, 
with other symptoms of too great excitement, will be the 
consequence. This state is called sthenic diathesis or 
disease. 

But if the stimulant power be pushed still further, the 
excitability will become gradually exhausted, till at last 
there will be too little to perform the healthy actions, even 
though there be plenty of stimulus. This is a state of 
disease, called indirect debility, or asthenic debility, be- 
cause it is not produced by directly subtracting the powers 
which support life, but indirectly by over-stimulating 
them. 

There is a state between perfect health and disease, 
called predisposition, in which, though the functions are 
undisturbed, the slightest cause will bring on disease, and 
more readily in tropical than other countries. 

Before I viewed diseases and their causes in this way, I 
must confess that I felt great hesitation in practice ; and 
judging merely from symptoms, which are often fallacious, 
the operation of a remedy often disappointed me, and I 
could not pretend to predict the event with the certainty 
that I now can. 

A man entrusted with the lives of his fellow creatures 
under circumstances so truly unfavourable, ought to pos- 
sess both the eye of the eagle and the courage of the lion ; 
he ought to be one whom 

" Non vultus instantis tyranni 
Mente quatit solida, neque auster 
Dux inquieti turbidus Adrise, 
Nec fulminantis magna manus J ovis." 

What man can view the lineaments of speedy dissolu- 



BILIOUS REMITTENT FEVER. 



15 



tioD marked on the brow of so many of his countrymen, 
without shuddering with horror? What man (I would 
ask) is there, that would not give the worth of India's 
richest gem, to possess the power of arresting the rapidity 
with which this disease advances ? — to check, as it were, 
the overwhelming force which too often hurries his patient 
from this world to the realms of eternal repose, whilst in 
the full tide of life. 

All symptoms must not be equally relied upon, for when 
but little danger appears pointed out by the aggregate of 
symptoms, the practitioner will often be astonished to find 
the result diametrically opposite to his most sanguine 
expectations. 

One of the characteristic features of this disease is the 
yellow suffusion of the skin, from which circumstance it 
derived the name of yellow fever. 

Doctor Bancroft remarks, " We may surely infer that the 
severe vomitings in this fever may cause the introduction 
of bile into the blood-vessels, and thus induce the yellow 
suffusion of the skin." 

If this circumstance occurs early, he, as do others, 
remarks, that such a symptom is unfavourable and alarm- 
ing, — but if slow in its advance, a favourable prognostic 
may be entertained. 

I, however, affirm, not altogether disagreeing with this 
remark, that the yellowness of the skin is by no means a 
common attendant in this disease during the course of the 
fever, but I have oftentimes seen it take place a few hours 
after death. 

How are we to account for the yellow tinge in the skin 
of those patients in whom no vomiting had existed dur- 
ing the illness? 

In what way are we to explain this peculiarity in such 



16 



BILIOUS REMITTENT FEVER. 



as survive after being early subject to this symptom, some 
extremely so ; and still, during the whole course of the 
disease, not the least symptom of vomiting was present ? 
1 have witnessed many cases of this kind. 

Suppose the vomiting, as it certainly appeared to Dr. 
Bancroft, to be presumed in many or in most instances to 
cause the yellow tinge ; it may be accounted for other- 
wise, by supposing that the bile, after being secreted and 
passing into the duodenum, is taken up together with the 
chyle, or perhaps the chyle being but badly formed, (or 
in some instances not at all,) a superabundance of bile 
remains, which is carried through the various passages to 
the left subclavian and jugular veins, and by further cir- 
culation (which during the disease is highly increased) 
becomes completely mixed with the blood. 

I look upon the following circumstances as particularly 
necessary to be impressed upon the minds of all who may 
hereafter witness this disease ; viz. whether the stomach 
be retentive, and what was the state of the bowels pre- 
vious to the effects of medicine. Should there be little or 
no vomiting, or should vomiting exist and be under con- 
trol, that is, be allayed by extract of opium, either simply 
or combined with calomel ; or that a solution of argent, 
nitrat. restrains this distressing symptom ; and if these 
fail, should it yield to the application of a blister to the 
scrobiculus cordis — such are for the most part favourable 
omens. A slight aberration may occur, but if it goes off 
as the morbid biliary secretions are kept up, no un- 
pleasant omen may be inferred. 

The pulse is not much to be relied upon ; still if uni- 
form, and not exceeding one hundred and twenty, even if 
it occasionally remits, it is not alarming. 

If a remission of the febrile symptoms take place be- 



BILIOUS REMITTENT FEVER. 



17 



tween the 24th and 36th hour, and leaves the skin 
moist, with or without yellow suffusion, I look upon the 
attack as mild. Let me, however, here remark that I have 
seen cases of irritable nervous temperament sink with 
only one attack ; collapse supervening when least anti- 
cipated. 

If the nervous system be not assailed, nor much dis- 
turbed, and preserve its integrity, and if vascular action 
can by prompt means be controlled, so much the better. 

We must not pause long at any period of the disease. 

The tongue ought to be particularly regarded. The 
tongue is connected with the stomach by the pneumo- 
gastric, or eighth pair of nerves : if it continue moist, and 
the patient does not complain of great thirst, you need 
not be alarmed. A dry, shrivelled, red tongue is a sign of 
great debility. 

A contracted, retracted, dry tongue is often met with 
in patients who breathe through the mouth ; in those who 
do not, it is diagnostic of gastro-intestinal disturbance. 

The colour of the tongue often varies from grayish- 
brown, yellowish-brown, dark-brown, and black. 

Should the patient in the second stage be attacked 
with rigor, an intermission inay be expected. This 
should not be lost sight of. 

Sleep at any period of the disease is favourable. 

Another marked sign of amendment is a general per- 
spiration breaking out over the whole surface of the body 
within the second or third day. When this occurs, the 
pains in the back, loins, and extremities, that were before 
complained of, are now either entirely gone, or are so 
trifling as not to incommode the patient. 

I depend much upon the appearance of the eyes ; when 
they are without the numerous injected blood-vessels so 

c 



18 



BILIOUS REMITTENT FEVER. 



often distributed over the conjunctiva, and free from a 
pungent sense of burning, there is not much inflamma- 
tory action present ; at least the brain is less disturbed. 
The colour of the sclerotic coat should be particularly re- 
garded ; it is in this membrane the first tinge of yellow is 
seen. 

Sleep must not be confounded with coma. 

That sleep is a favourable symptom 'cannot be doubted, 
as such a sleep is evidently an effect arising out of an 
improved state of the secretions, or because the system 
finds itself relieved from the mal-secretions which hitherto 
have proved a source of irritation. 

I do not place much reliance on the sometimes immo- 
derate and unquenchable thirst. In all cases of this 
fever there a prevailing desire for liquid. I have never 
observed any bad results by allowing patients a moderate 
(or even ad libitum) quantity of the light and very agree- 
able water from the young cocoa-nut. 

Galen treated very fully on the nature of the pulse. The 
endless variety of his combinations and distinctions will 
enable us to form but very vague conclusions. 

The pulse varies not only according to age, sex, tem- 
perament, &c, but is quite different in bed, sitting or 
standing up, asleep or awake, meditating or jovial, dur- 
ing pregnancy, either in the young or middle-aged ; it is 
influenced by sorrow, by eating and drinking, and indeed 
it changes with the same facility as our affections. 

We ought, therefore, never to admit as a rule of prac- 
tice, nor form an opinion upon the stroke of the pulse 
alone. 

Nor ought we to consult the pulse immediately on visit- 
ing a patient, because, very frequently, the shock of seeing 
you is sufficient to alter in the sick person the impulse of 
the circulation. 



BILIOUS REMITTENT FEVER. 



19 



Metaphorically speaking, I place no more faith in the 
pulse thus early consulted than in the fickle wind, which 
may be compared as equally uncertain and fallacious to 
the different pulse of women and children, sick or well. 
I may here reiterate an old expression, that it is impos- 
sible to deduce any knowledge of disease from the infan- 
tile pulse, which moves with such rapid irregularity as 
frequently not to be counted. Old people are subject to 
this irregularity, independent of any untoward symptom. 

I know a gentleman whose ordinary pulse is forty-five , 
seldom above fifty strokes in the minute when under the 
influence of stimulus. 

It is a fact, that neither frequency nor acceleration of 
the pulse proves the existence of fever. 

I have never been able to foretell, with any certainty, from 
the nature of the pulse at the onset of the disease, whether 
the fever would be of the continued remittent, or the in- 
termittent form. 

An easily compressed pulse is to be dreaded in the early 
stage of this disease. 

There are frequently observed, in this fever, eruptions 
about the lips; if they appear after thirty-six or forty- 
eight hours, I look upon it as indicative of a favourable 
termination to the disease; more so, certainly, if they 
shoot forth freely in small white shining pustules, and form 
into scab. 

Some authors remark that the tongue during the whole 
course of the disease is but little altered, and, if loaded in 
the early stages, is clean and florid before death. 

I hope I shall not incur the displeasure of these authors 
by mildly contradicting this sweeping assertion. A very 
few hours after a person is attacked by this disease, the 
tongue in general is coated over with an ash-coloured fur, 

c 2 



20 



BILIOUS REMITTENT FEVER. 



darker in some certainly than in others, but as the disease 
advances to the 3rd, 4th, 5th, or 7th day, it is seen 
darker and darker in proportion to the augmentation or 
danger of the disease ; and as the sides clean, and be- 
come of a beautiful red colour, the crust in the centre is 
more firmly adherent; it at length changes to dark and 
shrivelled, drawn to a sharp apex ; its muscular power so 
diminished, that it cannot be produced except with tremor 
and difficulty. 

This state indicates a diminished sensibility of the 
gustatory nerves, and general debility of the system ; this 
want of nervous energy is soon communicated to the lips, 
which are almost without motion or feeling, being, as it 
were, glued to the teeth by the accumulation of dark 
sordes. This is bad, very bad : it is not one iota more 
favourable if the tongue looks as if parboiled. 

We cannot expect to see, under any circumstances of 
visceral derangement, a healthy-looking tongue. 

A. medical friend of my acquaintance, who enjoys 
tolerable health, has the peculiarity of an uniformly foul 
tongue, such as would indicate at least a derangement of 
the digestive organs. If Abernethy were to see it, he 
would without hesitation direct a course of blue pill, 
&c. &c. 

There is much danger present if the tongue appears 
dry, rough, or ulcerated ; and if it becomes suddenly 
moist, without some other favourable symptoms, you may 
consider the patient in a very alarming state. 

Vomiting is always to be dreaded, particularly if it con- 
tinue during the remission. Incessant irritability of the 
stomach, with or without discharges of dark matter re_ 
sembling coffee-grounds ; if this is witnessed in the first 
paroxysm, the case is desperate. 



BILIOUS REMITTENT FEVER. 



21 



Discharges from this organ are frequently free from this 
particular, yet the dark particles become deposited if 
the fluid is suffered to stand a quarter or half an hour ; 
this is generally observed early in the disease, and indi- 
cates what is to follow. # 

The first glance we give a patient, we are astonished to 
see the general aspect of his countenance — his face un- 
usually flushed, his eyes brilliant, expressive of much ani- 
mation, and yet unconcern ; he answers with vivacity any 
question put to him, and although he will complain of 
thirst, headache, pains in the back, loins, and extremi- 
ties, he fancies very little the matter with himself at this 
period. Patients crave at this moment the indulgence of 
water. 

We find, as the disease advances to the second and 
third stage, the eyes have lost their lustre, and are 
marked by an evident expression of sadness, the counte- 
nance no longer evincing the animated look before ob- 
served, but is succeeded by as visible a contrast as it is 
possible to behold in the short time already elapsed. 

The muscles of the face become peculiarly marked, the 
nostrils drawn in, exhibiting a total metamorphose ; de- 
spair and anxiety appear predominating ; sigh follows sigh ; 
a difficult respiration is evident, accompanied with pres- 
sure about the praecordia. Tf he is sensible, he is in- 
different ; if otherwise, the delirium may be constant or 
partial ; and if the latter, patients will frequently endea- 
vour to leave their beds, nay the room. With these prog- 
nostic signs, we may almost consider the patient irre- 
trievably gone ; although there are instances of recovery 
taking place notwithstanding. 

* It is the gastric form of the fever, and the stomach is the organ which 
shows the greatest share of morbid derangement. 



22 



BILIOUS REMITTENT FEVER. 



At this period, and with the foregoing symptoms, I have 
known singultus with subsultus tendinum ; nothing can be 
worse. 

Great danger is to be apprehended, if a remission do 
not take place before the thirty-sixth or forty-eighth hour 
after the attack. 

If coma, stupor, and a total suspension (or nearly so) 
of the nervous influence ensue, such as deprivation of 
sight and hearing, all hope is at an end. 

That the brain in most instances is early affected, is 
evident from symptoms that the veriest tyro may discover 
at the bed-side. It would be a waste of time to detail the 
fatal omens which ocular demonstration so clearly points 
out. 

The preternatural heat which runs so unusually high 
may account for this in two ways, by acting on the ner- 
vous system, first by excitement, secondly by depression. 
The latter is almost always the most dangerous ; yet the 
excitement will oftentimes run so uncommonly high as to 
be on a par in danger, and I am uncertain which of the 
two is calculated to do most mischief. 

Let any careful observer place the thermometer under 
the tongue, or under the axilla, he will be astonished to 
find the mercury rise to 106-8 or 10°, with a rapid ar- 
terial action of from 120 to 140 pulsations in the minute. 
In such cases, our fears are on the stretch for the patient's 
safety. 

If the external heat of the skin exceed 108° or 110°, we 
may infer some dire mischief is going on. If it lasts any 
time, irreparable injury, with the extinction of life, will 
follow. 

The feel of the skin at this period imparts a sensation 
so peculiar that I want words to convey a just idea of it 



BILIOUS REMITTENT FEVER. 



2-3 



to the reader: we feel, on the first touch, an involuntary 
desire to withdraw the hand, and a repugnance to renew 
the operation. 

The heat of the skin should be more attended to than 
it is. Here I will not enter further on the subject, as a 
chapter on that head will be found in another part of this 
work. 

An inconstant heat, (not uniform during the second 
stage,) which is sometimes found confined to the head, 
neck, and breast, whilst the superior and inferior ex- 
tremities are not exactly cold, but to the feel below the 
standard of health, possessing, although not acute pain, a 
very disagreeable numbness, and an uneasy contracted 
sensation in the gastronemius muscles, is indicative of 
great danger; especially when a remission is observed 
with these symptoms, and the lower extremities betray a 
coldness little short of being death-like. 

All haemorrhages must be dreaded : if early > they are bad ; 
if in the advanced stage, fatal. 

If during the comatose state the half-closed eyelids 
expose any of the white, it is a deadly symptom. 

When tears escape involuntarily, it is a sure presage 
that death is close at hand. 

Involuntary discharges of urine or faeces, with cold 
clammy sweats, muttering, twitchings of the muscles of 
the face, show that mischief too serious to be arrested 
is at work, the termination of which is the extinction of 
life. 

The following prognostic of the Coan sage is strictly 
correct. 

If in ardent acute fever the patient grinds his teeth 
more than ordinary, delirium and death will follow. 

It is said that this disease can be confounded with 



24 



BILIOUS REMITTENT FEVER. 



typhus and pestes. It appears entirely different from 
these; from the former it can be distinguished from its 
attacking the young and vigorous, and the plethoric ; from 
the other it is to be distinguished by its seldom or ever 
being accompanied with swellings of the lympathic 
glands or carbuncles, and from its never attacking negroes. 

It is to be distinguished from almost all other fevers by 
its sudden invasion, the great prostration of strength, 
and the other symptoms already enumerated. 

The diagnostic marks are nearly the same ; and what I 
have set forth may be considered correct, with this obser- 
vation, that the remittent is the most prevailing form, and 
the disease is always more aggravated in the autumnal 
season. 

It is very rare to see the black vomit in the fevers of 
spring; and the deep yellow tinge of the skin is also 
rarely seen at that season of the year. 

Dissections have not afforded the satisfactory informa- 
tion expected from such examinations. Thus, sometimes, 
especially if the patient be cut off suddenly or early in the 
disease, little or no organic derangement can be observed. 
The blood appears to be completely decomposed, but at 
what period the decomposition commences in the ardent 
forms of this fever, I am not quite certain. I am inclined 
to think that the most dangerous cases are owing to this 
cause, and its consequent connexion with putrescency. 
Miasma has a sedative effect upon all constitutions; 
and when this very active and subtle poison enters the 
more or less predisposed, its influence upon the blood 
(circulation) must be great. 

A series of well-directed experiments may settle the 
question. 



BILIOUS REMITTENT FEVER. 



25 



In the vessels of the brain some congestion is apparent, 
and often serous effusion. 

The stomach is frequently found diseased in all those 
who die of the black vomit. 

There will always exist a sympathy between the brain 
and the stomach, and when the one is found diseased, the 
other will generally exhibit marks of inflammation. The 
real organ affected will generally show a greater extent of 
disease. 

Some have found the brain and spinal marrow more 
soft than natural ; others have found the brain increased. 
The pulmonary organs are not particularly affected. 

The stomach and duodenum are sometimes found co- 
vered with spots resembling erysipelatous gangrene. The 
liver is sometimes inflamed, and the gall-bladder contains 
dark-coloured bile ; sometimes it is nearly empty. 

The spleen is not much altered. 

The kidneys are seldom affected. 

The urinary bladder is sometimes found much con- 
tracted, containing a deposit of dark-coloured fluid. 

CAUSES. 

I have in another page given the opinions of several 
eminent writers on this head; the causes are, however, 
divided into predisponent and exciting. 

But this distinction cannot always hold good, because 
we do not know how some of these act in producing this 
fever ; and sometimes, such is the virulence of the ex- 
citing causes, that no predisposition is required, the fever 
attacking indiscriminately any individual. 

CLIMATE. 

This is one of the most essential causes, unquestionably, 



26 



BILIOUS REMITTENT FEVER. 



of this disease : for it is endemic in tropical countries, 
and never, until within these thirty or forty years, was it 
found beyond the limits of the tropics ; and even yet it 
has not existed beyond the 43° or 44° of north latitude. 

Jt attacks the indigenous inhabitants of these climates. 
Natives or Creoles are much less subject to it than 
strangers. When strangers have become seasoned to the 
climate, and lost their European constitution, they are less 
liable. 

If they have left the climate and returned to Europe, 
and remain any time, they are again liable : this I expe- 
rienced myself, in a very severe degree, after my return in 
the year 1824. 

It more especially attacks strangers who come from 
northern climates. Most melancholy instances of this oc- 
curred during the late war : for it happened that of those 
troops sent to St. Domingo, not a sixth part survived after the 
first twelve months. A similar mortality occurred in Ja- 
maica in the year 1819. Climate seems to act in inducing 
this fever, by rendering the body more irritable, and also by 
its favouring those causes which more immediately excite 
the disease. 

Great heat, conjoined with moisture, contributes very 
considerably to produce this disease in tropical countries. 

In the West India Islands it is most prevalent during 
great heats, and when the southern winds, which are hot 
and moist, prevail. 

It is at its greatest height in August and SejDtember, 
and ceases about January. But when the other causes 
are powerful, I have known it last nearly the whole year, 
as in 1824 to April 1826. — See casualty return of the 
77th regiment. 

- Climate may assuredly be considered as the most 



BILIOUS REMITTENT FEVER. 



27 



powerful of all predisposing causes, because the consti- 
tution undergoes a material change, and it is generally 
allowed that any sudden alteration or impediment to 
nature, in her wonted course, is not unfrequently suc- 
ceeded by some attack of disease instituted for the relief 
of the whole system. 

Hence the increase of perspirations, w T hich become 
dangerous under certain vicissitudes of temperature, from 
the sympathy existing between the skin and the liver. A 
total change of diet, exercise, nay, of everything, takes 
place ; all conspire to create a predisposition to the pre- 
vailing diseases, until the constitution or system becomes 
naturalised to the increased temperature. 

In this mountainous country the water rushes down in 
torrents during the rainy season, forming deep gulleys, 
and carrying with it various descriptions of vegetable sub- 
stances, which, on the water subsiding, become exposed 
to the rays of the sun in the flats, and there remain a 
sufficient time to undergo the process conducive to putre- 
faction : consequently, they will prove a source of disease 
to such as reside near their poisonous influence. 

Empedocles is said to have delivered the Salentini from 
the dangerous exhalations to which they were subjected, 
by conducting into their marshes two neighbouring rivers, 
which cleared them of the stagnant water, and the air 
was no longer tainted. 

The diseases to which they had been subjected from 
these miasmata consequently ceased also. 

A marshy situation seems to be a very powerful cause of 
the production of this fever in warm climates. For se- 
verity and frequency, low situations, on the banks of 
rivers, and on the sea-shore, surpass any other locality. 

In more northern climates, as in the American States, in 



28 



BILIOUS REMITTENT FEVER. 



Spain, and in Italy, this disease always ceases as the 
winter approaches. It is also less common in high situ- 
ations and in dry soils. It seldom occurs, even in the 
warmest countries, on elevated plains considerably above 
the level of the sea ; so that in this island, and in other 
tropical countries, the inhabitants of hills are compara- 
tively safe from this disease. 

Yet it has, to my knowledge, sometimes occurred in 
elevations above one thousand feet from the level of the 
sea, though it there assumes a mild remittent, and occa- 
sionally an intermittent form. There appear to be 
certain states and conditions of the atmosphere, inde- 
pendent of the conjunction of heat and moisture, which 
excite or render this fever more severe ; for it is at one 
time much more severe and fatal than at another, as will 
be seen in the early pages of this work, which detail the 
character of the prevailing diseases every month, from the 
year 1815 to 1830. These changes in the atmosphere, 
the more sudden they are, the more frequent is the disease. 

Exposure to night-damps is an agent of no ordinary 
power, and seldom fails to assist the unwary to a full 
proportion of suffering for his imprudence. 

Drunkenness is another no less powerful exciting cause. 
The moral character of an individual has also much to 
do, as persons addicted to ardent spirits suffer considerably 
more than persons of more temperate habits. 

It is probable, therefore, from all that I have adduced, 
that the endemic, bilious, remittent, or yellow fever of 
tropical countries arises from marsh miasmata, and that it 
assumes these formidable forms from the quality of the 
poison with which the atmosphere is impregnated ; and 
this poison is always more virulent in the autumnal 
season. 



BILIOUS REMITTENT FEVER. 



29 



Is it, or is it not, contagious ? has often been asked ; 
and no question has afforded a greater discordance of 
opinions amongst very eminent physicians. One sect, 
as Chisholm, Currie, Macltterick, Pugnett, Arejular, 
Pallani, Calliot, Threbaut, Bally, and many others, affirm 
that it is contagious. 

Another sect, as Devize, Valentin, Miller, Dalmas, 
Smith, Savarissi, Bancroft, Jackson, &c, have denied 
that the disease ever arises from contagion. 

In favour of the contagious nature of the cisease it has 
been said, that there is the same evidence as with respect 
to the plague : for this fever, they say, has been traced 
to its introduction by some person labouring under the 
disease, and that it rapidly spread in all those towns 
where the population was dense, as in Philadelphia, New 
York, in the southern coast of Spain, and in Gibraltar. 

It is also boldly asserted, that at Leghorn, in the year 
1804, it was clearly traced to a ship which came from 
the West Indies, and it gradually spread from that part of 
the town where it first appeared, until a large proportion 
of persons sickened and died of it. Doctor Rush, in his 
account of the epidemic of 1793 in Philadelphia, was 
decidedly of opinion that it was contagious. In the year 
1802 he maintained an opposite opinion, which he as- 
serted from political motives. His letter will be found in 
the Medical and Physical Journal, No. 58, vol. iv. He 
publicly retracts his opinion, and begs " forgiveness of the 
friends of science and humanity, if the publication of that 
opinion has had any influence in increasing the misery 
and mortality of that (this) disease." 

The contagionists are fast losing ground, particularly 
the disciples of Chisholm, than whom there could not be 
a more violent, illiberal, and more partial writer. He has 



30 



BILIOUS REMITTENT FEVER. 



accused the whole medical staff of the army, and loads 
them with the opprobrium of having caused the death of 
13,437 soldiers. This firm champion of contagion, after 
some short period, remarked with unblushing apostasy, 
" That when ships are placed within the reach of mias- 
mata, or local causes of diseases, which, at certain times, 
commonly produced the yellow fever, in the harbours 
of the West Indies," &c. ; and to this cause he attributes 
the events which occurred at St. Domingo. 

Some of this sect hold out, and support their opinions 
with great plausibility, that this disease has been stopped 
in its progress by the same precautions being taken which 
are found to stop the progress of other contagious diseases. 

It is before remarked, that the mortality at Leghorn, in 
the year 1804, was introduced by a ship which had ar- 
rived from the West Indies ; and it is possible, which I do 
not pretend to deny, that the first cases were seen amongst 
the crew of this ship ; but, at a place like Leghorn, it is no 
argument in favour of its imported contagious nature. 
The predisponent causes were already in existence (on 
board the ship) amongst the crew, who had suffered from 
a long voyage, fatigue, and very tempestuous weather, and 
the exciting cause was doubtless distinct from the ship. 
This is exactly what was attributed to the epidemic of 
1828 at Gibraltar, which I have quoted in my medical 
topography. 

On the other hand, its uncontagious nature has been 
maintained from the following facts : 

In the West Indies, where the disease is endemic, it 
has been alleged, with truth, that persons, by removing 
to a small distance from the infected atmosphere, as it 
has been denominated, have escaped the disease ; and 
the onset of squally weather, accompanied by rain and 



BILIOUS REMITTENT FEVER. 



31 



northerly winds, has been known to check the progress of 
this fever, and even to mitigate the symptoms of those 
who were suffering at the time. 

Of late years, almost all the practitioners in the Ame- 
rican States have declared against the infectious nature of 
the yellow fever, asserting that by removing from a spot 
where the disease raged, to a distance where the atmo- 
sphere was not infected, persons would escape. 

In the year 1 805, this fever appeared at New York, and 
spread such terror that almost the whole population aban- 
doned the town and encamped in the country r many at a 
very short distance from the suburbs. Yet, although there 
was a free communication betwixt the town and those 
who were encamped, no instance of the disease occurred 
among the latter ; many who had the disease fled to the 
neighbouring towns, even as far as Boston, without even 
communicating the disease to others. 

The population of New York at this period was 76,000. 
The city is about twenty-seven miles from the ocean, and 
washed on both sides by water of great depth. Doctor 
Miller clearly proved that the miasmata came to maturity 
on the one side, two or three weeks sooner than on the 
other. The authenticated returns stand thus : — Inhabi- 
tants, 75,770; of which 26,996 left the city; leaving 
48,774 : out of this number, 645 were attacked by the 
fever ; 302 of whom died. Compare this with the mor- 
tality of this island, during the prevalence of the epidemic 
of 1819. Between the 50th, 61st, and 92nd regiments, 
about 500 died of the prevailing fever. 

In Kingston, which contains about 40,000 souls, a great 
many civilians were carried off, but not in numbers to be 
compared with the average amongst the military. There 
was no alarm about contagion. Kingston at that time 



32 



BILIOUS REMITTENT EEVER. 



could boast of many very experienced and talented prac- 
titioners, with that learned and excellent physician, Doc- 
tor Bancroft, at their head, who says, and T cordially agree 
with him, " that there are many convincing proofs that 
the cause of the plague is perfectly distinct from, and un- 
connected with this fever." 

It is certain that the plague has never made its ap- 
pearance in Jamaica. 

This fever raged at Gibraltar in the years 1810, 1813, 
and 1814 ; and in order to set the matter of its con- 
tagious or non-contagious nature at rest, every pains was 
taken, and a series of questions propounded ; and the 
subject was dispassionately settled, that the epidemics of 
those years were engendered by local causes ; and as it 
only affected people on one side of the rock, it could not 
with any degree of propriety be called contagious. 

Such are the contradictory opinions respecting this 
disease. It would be impertinent in me to make any 
individious remarks on the subject of this dispute. 

It would now be in vain to deny the authorities by 
which each endeavoured to support his opinion ; and it 
would be thinking too little of human nature, to suppose 
that the authors were not convinced of their opinions. 

How then are we to reconcile opinions so opposite to 
each other, as the contagious or uncontagious nature of 
this disease ? 

I know no other (and I advance this with great defe- 
rence, yet supported by many anxious years of observa- 
tion,) than by supposing that the diseases described by 
those who maintain such opposite opinions, are really 
and bond fide different ; and that they have nothing in 
community but the yellowness of the skin, which is so 
common an occurrence in all diseases of tropical cli- 
mates. 



BILIOUS REMITTENT FEVER. 



33 



I also think that some authors have made up their 
minds too suddenly upon a question of such importance ; 
had they continued their observations steadily and im- 
partially, it is probable that the matter would have long 
since been settled. The opinions of Gilbert, Humboldt, 
and Clarke, go to prove that there are two distinct fevers, 
the one remittent, arising from atmospherical influence 
prevailing in a high degree ; and the other, a continued 
fever, arising from many causes, and ultimately in its 
severest state, like the continued fevers of our northern 
climate, becoming contagious. 

I can with safety assert that this disease sometimes 
puts on the remittent, and sometimes the continuous form, 
but more frequently the former. 

Does not the remittent fever often change its type to 
that of tertian or quotidian intermittent ? 

And why should not the yellow fever, which is a 
native of the same climate, have a similar peculiarity ? 

Is it not bona, fide one and the same disease appearing 
under different modifications ? 

To these questions I can only bring my mind to one 
answer, which I believe is now tolerably well known, 
that in the worst forms of the yellow remittent, the re- 
missions are less distinct than in the milder form, which 
is only a symptom of the severity of the disease, and 
common observation may denounce the type of the fever 
to be of the continued form, and distinct from contagion. 

Irresistible proofs exist, that although this disease is 
more fatal at one time than another, contagion has no 
part in contributing to the mortality. 



D 



34 



BILIOUS REMITTENT FEVER. 



PREDISPOSING CAUSES. 

All ages seem to be equally liable, but those of the ex- 
treme of life are less so. 

Women are less liable to it than men, probably because 
they are less exposed to the predisposing and exciting 
causes. 

Persons of sanguine temperament, of a robust constitu- 
tion and plethoric habit, and who live freely, are very 
liable to be affected. 

Those also who are of a spare habit, and who live upon 
a salt or nutritious diet, are very subject. 

The crowded parts of cities are generally composed of 
the labouring classes, poor, and persons in low circum- 
stances, and consequently, are more predisposed to dis- 
ease, from the want of proper ventilation, cleanliness, and 
frequently the necessaries of life ; such instances have 
been quoted as arguments in favour of contagion: I con- 
fess I go hand in hand with Dr. Bancroft on this head. 

The depressing passions of the mind are observed to 
favour very much the effects of this disease, and none 
more liable than the timid, and those who most dread its 
attack. 

It has been remarked by one or two respectable authors 
that subjects naturally hypochondriacal are always exempt 
from this disease, but with how much truth I confess my 
experience cannot confirm. 

The negro race are very seldom attacked ; but the mixed 
races, if they approximate to the customs and manners of 
the Europeans, are not exempt. 

Fatigue contributes mainly to predispose to this dis- 
ease, particularly pedestrian exercise in the heat of the sun. 



BILIOUS REMITTENT FEVER. 



35 



Every species of intemperance cannot be too rigidly 
forbidden. 

Children appear to be less subject to the disease, and 
are rarely affected; I have, however, witnessed cases. 
They are of course less exposed to all the predisposing 
causes. 

PROXIMATE CAUSES. 

Various opinions have been entertained respecting the 
proximate cause of this fever. It has been described as 
the state which induces typhus fever, as putridity, or de- 
praved state of the red globules of the blood. 

That the blood undergoes material changes is self- 
evident. A careful observer of symptoms knows this fact ; 
but at what period in the disease this depraved state of the 
red globules of the blood takes place, the nicest discrimi- 
nation can hardly detect. 

Sir Gilbert Blane and others have ascribed it to in- 
flammation of the brain ; to derangement of the hepatic 
system ; to inflammation of the liver ; to absorption of the 
bile, &c. 

These are unsupported by proofs drawn from dissec- 
tions of those who have died. # 

* I have dissected many subjects who died of this disease, and, after very- 
minute and patient examination, I have frequently been led to this perplex- 
ing conclusion, — that neither the brain, lungs, heart, liver, stomach, nor in- 
testines, exhibited any marks of morbid action which could have deprived the 
patients so suddenly of life. 

Is it not, therefore, a reasonable inference to suppose a decomposition in 
the component parts of the blood to have mainly contributed to the want of 
nervous energy witnessed in the various stages of this disease, and the 
subsequent unaccountable loss of life in every variety of age, sex, and tem- 
perament? - • 

D 2 



36 



BILIOUS REMITTENT FEVER. 



The liver and stomach are frequently, the latter parti- 
cularly, found diseased after death. The gastric symp- 
toms present in the early stage of the disease favour this 
supposition. 

We must, however, confess that much information is 
wanted on this head. Chemical analysis, it is hoped, will 
ere long unravel the mystery.* 

* Jackson says, " The proximate cause of this disease is a subject of a 
dark nature. It is such, perhaps, as our limited capacities will never develope. 
But though we despair of ever attaining clear ideas of its specific nature, 
there are still some useful circumstances connected with it, which we com- 
prehend with clearness. 

" We know that the more general remote causes of fevers are certain in- 
visible exhalations, sometimes more evidently arising from marshy grounds, 
sometimes more obscurely diffused in the air, and sometimes, it is said, pro- 
ceeding from the bodies of our fellow-creatures. On this latter supposition 
no reliance can be placed ; the matter is finally settled to the contrary. The 
nature of these effluvia is vague ; we can arrive at no certainty ; it is only hy 
conjecture that we trace them in the channels by which they enter the body. 
The changes which they produce on the solids, fluids, or nervous system, 
before their action becomes obvious, are totally unknown to us at the present 
day. A space of time intervenes before it is capable of producing a 
fever, or the paroxysm of a fever. The cause of the disease, so far from 
producing fever immediately when taken up by the body, often lurks for a con- 
siderable time in the constitution, without perceptibly injurying the ordinary 
actions of life. It gives rise to affections which are apparently very different 
from their real nature. 

" In other cases the attack of the disease is sudden, and its formation from 
the beginning distinct. 

" This fact affords a presumption, that in consequence of a particular modi- 
fication, which is only accomplished in a certain space of time, but the na- 
ture of which is incomprehensible, an aptitude is regenerated between the 
remote cause of the disease and the relative state of the body. 

" When the state of the body and the remote cause approach to, or ar- 
rive at, a state of mutual correspondence, the disease is produced. When 
this state, which may be called aptitude, is changed or destroyed, the dis- 
ease vanishes, or suffers a change of form. 

" This is all that we know of the proximate cause of fevers " 



BILIOUS REMITTENT 



FEVER. 



37 



CAUSES OF THE SYMPTOMS. 

On this head it is not necessary to inquire into that of 
the febrile symptoms, as the cause of these does not 
differ from that of other fevers ; but the cause of the pe- 
culiar symptoms in the yellowness of the skin, which is 
sometimes universal, sometimes appearing in spots only. 

This is seen to come on in the first, second, and third 
stages of the disease ; sometimes before the lapse of 
twenty-four hours, sometimes not until the disease has 
continued some days, and sometimes not until after death. 
This extraordinary occurrence struck me as remarkable, 
never having seen it mentioned by any writer. 

Evidently the absorbents are at work after death. How 
otherwise are we to account for the latter phenomenon ? 

The yellow tinge has been ascribed to the absorption 
of the bile ; to the alteration of the serum of the blood. 
Perhaps both causes contribute. Any interruption of the 
course of the bile, after it is separated from the liver, &c. 
may cause it to be taken up by the absorbents, if the 
orifice of the duodenum is closed ; but this may exist with 
or without bilious vomitings. 

The bile is secreted in quantity, and rapidly absorbed 
by the vomitings increasing the action of the absorbents, 
and propelling it backwards into the gall-bladder and 
biliary ducts. 

I have seen the intestines partake of this tinge. 

The yellow spots, and that which occurs after death, 
seem to be owing to the effusion of serum and its altera- 
tion, which may have the power of exciting the action of 
the absorbents after death, and before the body is cold. 

The black vomit was formerly ascribed to an alteration 



38 



BILIOUS REMITTENT FEVER. 



of the bile ; but, from dissections, it appears to be owing 
to the effusion of blood from the rupture of minute blood- 
vessels in the stomach ; for the matter ejected is not 
bitter, its colour does not become green or yellow by dif- 
fusion in water ; it has been described as tasteless and 
innoxious. Many traces of the same matter may be 
pressed out in different parts of the intestines, which 
will clearly exhibit marks of congestion and inflammation. 

TREATMENT. 

If we could believe Chisholm and others, this disease 
could be as speedily cured as the lues, and by the inter- 
position of the same remedy, (mercury). These days are 
gone by, and experience has founded a more rational 
practice than adhering to any favourite remedy or sets of 
remedies. The discordance of opinions amongst practi- 
tioners on this head has emanated in pique and the love 
of novelty, and probably each viewing the disease differ- 
ently may have led to this variety. 

When I was an assistant to Dr. Alexander Murchison 
of Vere, than whom there was not a more experienced and 
talented practitioner in the island, many aggravated cases of 
fever came under my observation.^ The district was con- 
sidered an unhealthy one, but more particularly so during 
the autumnal months. I have a perfect recollection of 
the first severe case of fever, and the energetic manner in 

* Let me here take an opportunity of acknowledging my gratitude for the 
benefit I derived by his experience and instruction, and the many kind acts 
of attention I experienced uuder his roof ; they can never be effaced from 
my memory. I am also particularly indebted to the late Drs. Farquhar and 
Ashmeade, who imparted their knowledge frankly and freely ; and I am 
forced to acknowledge 1 hold testimonials of their approval of my professional 
abilities in the earliest part of my career. 



BILIOUS REMITTENT FEVER. 



39 



which he treated it. I say that I was astonished to be- 
hold the sudden invasion of disease in this patient, and to 
witness the subsequent truly formidable symptoms which 
so soon occurred, so new to me, so incomprehensible in 
the order and variety of their appearance, running one 
into the other in all the subtle confusion with which the 
disease is beset, that I candidly confess the feelings which 
the sufferings of this patient awakened in my breast I 
have never been able to describe. I saw him in appa- 
rent health the day before, and in the interval of a few 
hours he was writhing under the greatest agony. It 
made so deep an impression upon my mind, that I de- 
termined ever after to take notes at the bedside of every 
case I was called to, not trusting to memory, but care- 
fully registering the effects of remedies, the symptoms, 
and the changes effected in the system from day to day. 
This plan I have continued to the present moment, now 
nearly twenty years. During the whole period, with the 
exception of an absence from the island for about eighteen 
months, I have been in extensive civil and military prac- 
tice. It was during the year 1815, when I first had 
charge of a military hospital, that an opportunity pre- 
sented itself of gratifying a strong desire to examine a 
post mortem case of this disease which in civil practice 
is seldom or never permitted. 

This dissection afforded me a great deal of practical in- 
formation ; it enabled me to judge whether the morbid 
appearances were such as the symptoms indicated ; and 
whether the remedies were such as appeared calculated to 
relieve the system : it is recorded in this work, — vide George 
Anthony, Royal Foreign Artillery, My readers may judge 
for themselves. 

It is admitted that the cause of fever, be it what it may, 



40 



BILIOUS REMITTENT FEVER. 



has a general tendency to destroy the powers of life ; whe- 
ther in the child, in the delicate female, in the young and 
vigorous male, or in patients more advanced in years. If 
it is admitted that there is a principle in the animal eco- 
nomy which may resist, to a certain degree, the destructive 
powers of this fever, owing to a variety of circumstances 
which our limited knowledge cannot account for, should 
not our practice be directed to watching the salutary 
efforts of nature, and attending to her calls, rather than 
to a prodigal introduction of medicines ? 

This disease, as I have previously remarked, marches 
on with gigantic strides, totally interdicting any pause. 
We must summon all our energy at once, to be ready, bold, 
and decisive. 

We cannot, says an intelligent author, take the business 
entirely out of the hands of nature ; we can, in fact, go no 
farther than to oppose her pernicious efforts, or to ob- 
viate the fatal tendencies of the disease. The fatal 
tendencies are variously modified, and the means by 
which they must be obviated are sometimes directly 
opposite. 

All this is clearly understood, and needs no further com- 
ment from me. In speaking of the treatment of this disease, 
I shall proceed, seriatim, first, with blood-letting ; the in- 
dications and contra-indications of this favourite, formida- 
ble, and fashionable remedy. 

BLOOD-LETTING. 

The abstraction of blood, not many years ago, was 
looked upon as the surest means of destruction. 

I can now, with tolerable confidence, state ray opinion, 
having had opportunities of judging. 



BILIOUS REMITTENT FEVER. 



41 



Hippocrates forbids bleeding in warm countries, par- 
ticularly in bilious fevers.* 

Others recommend the abstraction of blood as the only 
means of cure. 

Others condemn it as the most certain means of de- 
struction. 

This disagreement may depend upon a great variety of 
causes, but more especially the period of disease. 

The great determination to the head, which occurs in 
the first stage, and other symptoms, seem to point out the 
employment of general, at least of topical bleeding ; and 
probably if it be used at an early period of the disease, 
and prudently, it must be attended with considerable 
benefit; but if delayed to the periods later, it has unquestion- 
ably proved highly injurious and detrimental. And here it is 
that it has so often produced terrible effects. Many have 
been ushered to an untimely grave by this remedy im- 
properly performed. But then, like every other remedy, 
we must not condemn it without just cause. Jackson, 
who was a keen observer, recommends bleeding, to an 
extent I have never been able to practise, as the surest 
means of arresting this formidable disease. 

By bleeding it is meant to fulfil four indications : 

1st. To divert the increased impulse of the blood from 
an essential part. 

2nd. To relax contraction ; and to allay the spasmodic 
action. 

3rd. To reduce the mass of blood. 
4th. To reduce inordinate re-action. 
The indications of too great reaction of the sangui- 
ferous system are taken from the state of the eyes and pulse. 

* Cose Praenot. sec. 2. 



42 



BILIOUS REMITTENT FEVER. 



If the pulse is strong, hard, vibratory, unequal ; — bleed, 
by all means, in the early stage, both general and topical, 
by cupping glasses to any particular part affected. Young 
plethoric patients, newly arrived in the country, demand 
prompt relief by this remedy. Females should be bled 
with more caution than males; but they derive great 
benefit by this evacuation keeping the temperament in 
view in both, in all cases. 

In young plethoric patients who have been subject to 
ophthalmia, when they are assailed with this fever, they 
complain from the first moment of headache and pain in 
the eyes. A momentary glance at the visage will at once 
point out the necessity of the immediate use of the lancet. 

Aphorism. — I hold it as a general rule never to bleed 
when the skin is moist, unless there exist some deter- 
mination to a particular part, and then I prefer topical to 
general bleeding. The state of the eyes cannot be too 
particularly attended to, as they furnish an unerring index 
to our practice in directing the use of the lancet : — id est, 
if they are shining, suffused, turgescent, with an inca- 
pability to bear light, be bold in the use of the lancet. 

If the pulse yield easily to the impression of the finger; 
if there co-exist symptoms indicating anxiety and pros- 
tration, although the patient appear young and robust, 
bleeding is contra-indicated : if they (patients of this tem- 
perament) are bled, they sink, frequently to rise no more. 

We find, in the early stages of this fever, diminution of 
strength, singing in the ears, sadness, fear, vertigo, 
trembling of the limbs. Symptoms such as these, which 
are so often met with in conjunction with others, posi- 
tively forbid the abstraction of blood in any subject. 

Cachectic patients bear the loss of blood very badly : 



BILIOUS REMITTENT FEVER. 



43 



great discrimination is required before this powerful 
remedy is adopted in such cases. 

Patients of phlegmatic temperament should be bled 
with great caution ; I have found it very seldom requisite, 
even in the aggravated forms of this fever ; although they 
should complain of pain in the back, loins, headache, and 
thirst ; the rigors are succeeded by pyrexia, with the 
above common attendants. 

I have often been asked if bleeding is to be repeated, 
and at what period, and under what circumstances ? 
Every practitioner, before he determines upon a repetition 
of bleeding in this fever, will have examined attentively 
the effects of the first evacuation. Sailors, for instance, 
generally faint after the loss of a few ounces, and in a few 
hours' time will bear a copious bleeding very well. 

By quoting the words of an intelligent writer on this 
head, I shall save my readers much time, and come to a 
very satisfactory answer to the above question, which 
should be our guide in this fever. 

" I lay it down then as a maxim, that if the disease is 
complicated ; if, after the symptoms before mentioned, it 
appears to partake of the inflammatory nature ; if the 
patient has been relieved by the former bleeding ; if the 
pulse remain good ; if the symptoms of reaction or impe- 
tuous motion towards an important organ diminish, and 
yet that the symptoms which determined the first bleed- 
ing still persist to a certain degree, we may proceed to a 
second. 

To the question, whether bleeding should be at all 
practised after the fourth day ? 

There is no particular rule to be laid down in answer 
to this question. I have frequently bled patients after the 



44 



BILIOUS REMITTENT FEVER* 



fourth, nay, even as late as the ninth and tenth days, and 
with much advantage. I did so to a young lady, not long 
since, who complained of great heat and burning sen- 
sation in the head, neck, and* chest : these symptoms 
vanished two hours after the loss of sixteen ounces of 
blood. 

I think it of consequence to state, that a few years ago I 
was asked by a physician of considerable experience in 
the parish where I resided, the following question — Whe- 
ther I would bleed a patient attacked with the usual 
symptoms of bilious remittent fever, if I was aware that 
she had a sanguineous evacuation at the time ? I answered, if 
she was young and plethoric, and of sanguine temperament, 
I would at once bleed her copiously, if there were no other 
contra-indications. If of a phlegmatic, or cachectic tem- 
perament, it were next to madness to attempt it. 

A lady was delivered of her sixth child; on the fourth 
day she had severe pain in the back, loins, and head, ac- 
companied with evident peritoneal inflammation. Warm 
baths, aperients, and fomentations were resorted to before 
I visited her. I had not been four hours in the house ere 
a fresh train of symptoms invaded her, which could 
not be mistaken for gastric bilious remittent fever. I 
directed thirty ounces of blood to be taken from the arm, 
wilich before night relieved the distressing symptoms ; 
she eventually recovered, by attending chiefly to the state 
of her bowels, and keeping down the temperature. 

It is worthy of remark that her accouchement was diffi- 
cult, and she suffered from severe flooding. 

The question concerning the propriety of bleeding in 
intermittent fevers has of late years been determined. I 
have, however, guided my practice in Jamaica chiefly by 



BILIOUS REMITTENT FEVER. 



45 



considering if bark or quinine has little or no effect in 
arresting the disease, then I bleed in the cold stage, and 
often with marked benefit. This plan must be adopted 
with great caution. Dropsy will often follow a protracted 
intermittent. 

I shall now proceed to the next order of remedies. 

EMETICS. 

My experience teaches me to say, that emetics should 
never be administered after the first few hours. Indeed, 
they had better be left out of the cure altogether, as they 
generally prove injurious, especially in careless hands. 

Dr. Lind says, that if a patient be bled a few hours after 
the attack, and James's powder, or some other antimonial, 
be given, so that an emetic and cathartic effect be pro- 
duced, the disease will be cured. 

Dr. Hillary says, that he found great advantage from 
encouraging the natural vomiting by warm water and a 
small quantity of green tea. 

The great irritability of the stomach, at the early period 
or commencement of the disease, should induce us to use 
emetics with great caution. 

With regard to Dr. Lind's practice in giving emetics, 
it appears pretty clear to me that he could only have seen 
the milder forms of the disease, or, probably, a different 
disease, which had nothing in common with bilious remit- 
tent fever but irritability of the stomach. 

Almost all the practitioners for the last twenty years 
reprobate, in strong terms, the use of antimonial emetics. 

It has been my most anxious desire, in every case, to 
check this extraordinary tendency to vomiting ; and the 
sooner this end is achieved the better. It is incalculable 



46 



BILIOUS REMITTENT FEVER. 



what mischief may be done by the loss of a few hours, 
and I know of nothing more likely to effect this, than the 
distressing irritability so often present in the early stages 
of this fever ; it baffles every other mode of relief ; the 
practitioner is harassed and perplexed to witness the 
ejection of every article, fluid or in substance, pills or 
powders ; and this continues until the patient is worn out 
and irrecoverably lost. 

ANTI-EMETICS. 

Under this head, which is assuredly a most important 
one, I consider it a sine qua non to put the stomach to 
rest as soon as possible ; and the remedies at hand, which 
will for the most part answer this desirable end, are few 
and uncomplicated ; they consist of vegetable as well as 
mineral, given in the form of liquid and pills ; and we 
have also a very useful adjuvant to assist this object by 
the application of emplast. lyttse to the scrobiculus cordis. 
Of vegetables, the first, which is in very general use, is the 
nutty root of the Adrue. Cyperus, CI. 3 or 1. Triandria 
monogynia — nat. or — calamaria. The glumes are chaffy, 
imbricate in two rows : scales, ovate ; keeled, flat, in- 
flected, separating the flowers, no corolla ; stamina, three 
short ; anthers, oblong and furrowed ; germen small ; 
style long ; stigmas, three capillary ; seed single, three- 
sided, acuminate, destitute of villus. 

The roots are aromatic, stimulant, and anti-emetic, may 
be used as a substitute for Rad. Serpenteria. 

The following account of the virtues of this valuable 
plant is from the manuscript of Dr. Cowan, of the Royal 
College of Physicians in London : 

" The discovery of its surprising properties was made by 



BILIOUS REMITTENT FEVER. 



47 



Dr. Howel, of Jamaica, in checking and restraining black 
vomit in yellow fever. A strong infusion of this plant is 
as much a specific in restraining vomiting in yellow fever, 
as the Peruvian bark in the cure of intermittent. The 
first teacup ful of the decoction or infusion represses the 
vomiting; the second or third cures. 

" By experiments made on the use of the different parts 
of the plant, it is found that the strongest is made by 
boiling the whole plant, cut or sliced, roots, seeds, leaves, 
and stem, all together : the quantity, two handfuls in 
three pints of water, boiled to the evaporation of one-third." 

There is no doubt of its efficacy ! Opium, simple and 
combined with calomel and the oil of capsicum, is fre- 
quently found very efficacious in allaying irritability. 

Of late years, many of the army medical officers 
have introduced a solution of argent, nitrat., which 
appears to have answered their most sanguine expec- 
tations. I have not had much experience in the efficacy 
of this active mineral sedative ; but, in the cases in which 
I administered it, the full benefit was derived — it is sim- 
ple and easily taken. It appears to me to act better 
in females than with males, two or three doses being 
sufficient. 

The usual method of preparing and administering it is 
as follows: — Dissolve two grains in one ounce of rose- 
water ; give five to ten drops in one ounce of any fluid 
most agreeable to the patient. 

CATHARTICS. 

Cathartics are the most useful remedies employed ; if 
neglected, the patient may be booked for a visit to the 
valley of the shadow of death. It has been said that 
when a first evacuation was procured, the greatest benefit 



48 



BILIOUS REMITTENT FEVER. 



has been obtained, while others have affirmed — will it be 
believed? — that when this has taken place, death has 
always ensued. Eheu ! Eheu ! 

Constipation is a frequent symptom of this disease, and 
as the contents of the alimentary canal seem to be in a 
morbid state, cathartics are indispensable, as the only 
means of removing a great cause of irritation. 

The first of this class of remedies is the submuriate of 
mercury ; it appears to have been the favourite for many 
years ; and at the present time it is highly patronised by 
every skilful practitioner in navy, army, and in civil 
practice ; but it is not so lavishly introduced as formerly, 
(except by Mr. Linton, whose sole reliance is upon this 
remedy.) This I suppose to have arisen in consequence 
of medical men, being disappointed with its cathartic 
effect, having pushed it to an enormous extent without any 
effect ; showing the great torpidity of the intestines ; some 
drams have been given. 

Mercury, given so as to induce its peculiar affection on 
the system and salivary glands, has been highly extolled 
by some, who have asserted that when it has produced its 
specific effect, recovery has always taken place. 

I have certainly seen hopeless cases recover as soon as 
the glands became fairly affected ; but when the ab- 
sorbents are in such a torpid state, it will be found ex- 
ceedingly difficult to obtain this end. A few years ago I 
was consulted by a practitioner who had been unsuccessful 
in some cases, in all of which he had persevered with 
mercury for the purpose of inducing salivation. In- 
unction was not omitted. Seven of the cases alluded to 
took upwards of four hundred grains ; two had swallowed 
seven hundred grains. This was the statement when I 
saw three of the cases ; — they died. It is a remarkable 



BILIOUS REMITTENT FEVER. 



49 



circumstance that so large a quantity of an active mineral 
can be exhibited before any effect is produced. Dr. 
Chisholm mentions a case in which four hundred grains 
were given before the salivary glands were affected. My 
practice has, however, furnished but few of these very 
obstinate cases of torpor ; and I cannot be persuaded to 
believe it a rational mode of practice solely to depend 
upon one remedy, under the supposition, that in time it 
must produce its own peculiar change in the system. 
Hundreds upon hundreds have been hurried from this 
transitory world in consequence of such practice. If 
salivation is the only hope, it is rarely produced by large 
doses of the mineral ; very small doses appear to me as 
much more likely to produce the effect. A solution of 
the oxymuriate has been tried with benefit. 

As this disease admits of no pause, I consider it wilful 
temerity, and most unpardonable conduct, in any prac- 
titioner having charge of the sick, to play with life at 
such fearful odds. Calomel, combined with extract, colo- 
cynth. comp., is an excellent remedy, and where it can be 
administered it unquestionably should be so, as soon 
after the patient complains as possible. Dr. Rush and 
others combined jalap with calomel, ten grains of each as a 
dose, and repeated it every four or five hours, until a full 
cathartic effect is produced. He was a keen observer, and 
a very successful practitioner. 

Calomel may be combined, with much advantage, with 
castor oil and sweet oil, adding a few drops of com. spirit 
of ammonia ; it mingles easily, and is easily taken ; and, 
by its minute division, it acts upon a larger proportion of 
the stomach than when given by itself. I have used it 
thus combined with very great success. If the stomach is 

E 



50 



BILIOUS REMITTENT FEVER. 



quiet, it is seldom rejected: it may be repeated every three 
or four hours, according to circumstances. 

It will be unnecessary to speak of the other numerous 
cathartics, the powers of which are so well known ; and 
as the judgment of the practitioner should not be fettered, 
I shall proceed to the next remedy. 

COLD AFFUSION. 

This process, the most important of all our remedies, 
has been practised by physicians in days long gone by. 
It was revived, and particularly recommended by Dr. 
Currie of Liverpool, in the treatment of typhus fever. The 
extraordinary success of his treatment will be seen on 
reference to his valuable work on that disease. 

It is indicated, " first in low contagious fever, accom- 
panied with headache, restlessness and shivering, pain in 
the back and over the body, foul tongue, and great pros- 
tration of strength ; the heat of the body, 102° or 103°, 
or more." These are symptoms generally observed in the 
bilious remittent fever of all hot climates. 

Secondly, " the remedy should be employed at the 
maximum of heat and exacerbation in the first stage." 

Thirdly, it is affusion, not immersion, that must be 
employed. 

In fevers arising from, or accompanied by, topical in- 
flammation, it is contra-indicated. The warm affusion is 
evidently better under such circumstances. 

In the last edition of Dr. Currie's report he says, 
" Though I have used the cold affusion, in some instances, 
so late as the twelfth or fourteenth day of contagious fever, 
with safety and success, yet it can only be employed, at 



BILIOUS REMITTENT FEVER. 



51 



this advanced period, in the instances in which the heat 
keeps up steadily above the natural standard, and the 
respiration continues free. 

" In such cases 1 have seen it appease agitation and 
restlessness, dissipate delirium, and, as it were, snatch the 
patient from impending dissolution." 

As the external heat of the remittent fever is manifestly 
higher than in any other fever, the cold affusion seems to 
be particularly indicated, and should never be omitted 
when the heat which prevails is above 102°. 

Some patients, however, stand the shock very badly; 
with such it should never be repeated ; sponging the 
whole body with cold water, made aromatic with eau de 
Cologne, is always of service, whilst, at the same time, it 
is particularly grateful to every class of patients. 

In a work published by Jean Francois Bastien, 1788, 
some very good remarks will be found on this head. He 
says, " L'habitude des Negres qui veulent," &c, who wish 
to cure themselves of fever, is to throw themselves into 
the coldest water to bathe, and cover their heads with 
fresh leaves and herbs, which they gather from the bottom 
of rivers. He saw the practice tried on whites, who ac- 
knowledged that it removed the headache and heat of 
fever. They change the leaves almost every moment. 
He tried the remedy on himself, but he asks, why should 
the remedy be doubted ? 

Chardin says that in some places in the East they know 
no other cure than to throw pails of the coldest water 
over the body. "Qu'on se rappele ce que rapporte 
Chardin, de la rnaniere dont la nevre se guerit en quelques 
lieux de l'Orient, ou Ton ne connait d'autre cure que de 
se faire jeter sur le corps des seaux de l'eau la plus 
fraiche." The Indians of the Mosquito shore place ex- 

e 2 



52 



BILIOUS REMITTENT FEVER. 



traordinary faith in this custom. A very remarkable case 
was communicated to me by an intelligent gentleman who 
has been in the habit of trading amongst them for many 
years ; he is intimately acquainted with all their customs 
and manners. The better informed of the various tribes 
know many valuable native plants for the cure of sundry 
diseases which they are subject to : the most essential are 
those possessing emetic, cathartic, and narcotic qualities. 
" It is surprising to see how well they know, when any 
of these agents, so different in effect, are required, and 
how exactly they prepare the given quantity for all ages 
and purposes.'' 

In fevers, pains, bruises, and wounds, they use nothing 
but cold water, applied in different ways. In the case 
of an Indian who was wounded in an engagement, on 
board this gentleman's armed schooner, with a pirate 
vessel off Boco-tora, in 1822, as soon as he landed he 
made all haste to his residence, and adopted the following 
plan : he took a large calabash, half filled with river sand, 
previously perforating the bottom of the vessel with 
several small holes ; having suspended it to a beam, he 
hereupon directed his wife to fill the vessel with water, 
whenever it was required, and directly under it he placed 
his lacerated and contused arm, and, seated by the side 
of a small table, held it in an extended position, resting 
on the table, several hours during the day and night, 
allowing the water to fall on his arm constantly. This 
was persevered in until all pain, and swelling, and in- 
flammation ceased. 

The cold and shower bath have never been tried suf- 
ficiently in this country to warrant a recommendation. It 
was popular for a very short period, and all at once aban- 
doned, from what cause I know not. I have seldom 



BILIOUS REMITTENT FEVEE. 



53 



employed either one or the other, except in the earliest 
stages and when the heat is above 105°, and the patient 
has been previously stripped, and sponged all over for five 
minutes. They stand the shock much better by adopting 
this precautionary measure. 

I once saw death follow the shock of the shower-bath ; 
it was, no doubt, injudiciously advised ; collapse took 
place, and no means which were resorted to removed it. 

SUDORIFICS. 

Sudorifics have never been, so far as my knowledge 
goes, pushed to any extent ; but if they really are so effi- 
cacious as they are said to be in typhus and the plague, 
they should be tried. 

For this purpose the vapour-bath would be most ad- 
visable. Of late years, the warm slipper-bath is much 
more frequently used than formerly, — it is an admirable 
adjuvant to other remedies, and is particularly indicated in 
the onset of the severer forms of this fever, in the young- 
plethoric subjects, previous to venesection ; which may be 
performed with safety, after Jackson's plan, while im- 
mersed in the bath. 

It is also one of those remedies which can be repeated 
often without doing mischief. 

REFRIGERANTS. 

Refrigerants, such as acids, must be grateful in this 
disease, where the heat and thirst are considerable, and 
accordingly are much employed. 

Oily frictions, which have been found so useful as a 
preservative, and as a cure for the plague, have been em- 



54 



BILIOUS REMITTENT FEVER. 



ployed, according to Humboldt, in the yellow fever which 
appeared at Vera Cruz and other parts of the South 
American continent. I have never seen it tried here, and 
therefore must remain silent on the subject. Positive in- 
formation of its efficacy could not be obtained in this 
country. 

TONICS AND STIMULANTS. 

Of course these can only be useful in the later stages 
of the fever, when debility is manifestly approaching. 

Accordingly we find they have been reprobated by 
many practitioners. Quinine, with an infusion of sarsa- 
parilla and Madeira wine, can be employed at times 
previously to the debilitated state, if the remissions are 
carefully watched ; but these articles are more particularly 
called for when a perfect remission can undoubtedly be 
observed. By a prompt and steady perseverance for a 
few hours, a remission has been prolonged to the seventh 
hour, and frequently the next paroxysm has been com- 
paratively mild. This is not always to be depended 
upon ; it should, however, never be lost sight of. As 
I have before remarked in the chapter on prognostics, 
it requires an eagle eye to hit upon the exact moment 
when these powerful auxiliaries can be introduced. I 
have no hesitation in saying, many a fever has been cut 
short by such means. 

Cayenne pepper, aether, camphor, and ammonia, have 
the reputation of being decidedly useful. 

Epispastics and sinapisms have been, and are to this 
day, liberally employed, and deserve to keep their place 
in our practice in this disease. 

Antiseptics are, indeed, but feeble means ; when they 



BILIOUS REMITTENT FEVER. 



55 



appear to be called for, the patients are generally at the 
threshold of the mausoleum of the king of terrors. 

They have been employed under the idea that the 
disease was owing to a putrid state of the fluids ; but as 
it is not exactly ascertained at what period of the disease 
this takes place, or until the power of the system is ex- 
hausted and irrecoverable, these remedies, at present, have 
very little weight in practice.* 

Having enumerated most of the remedies to be em- 
ployed in the treatment of this disease ; the indications 
which call for their interposition ; and the contraindi- 
cations which forbid their adoption ; I shall now proceed 
to state, as perspicuously as possible, the line of practice 
most applicable to afford relief to such as are attacked 
with the disease. 

It is said that the disease seems to run its course, what- 
ever means may have been employed to arrest its pro- 
gress, which is generally so fatal. This remark would 
have held its ground some fifty or sixty years since ; of 
late years the disease is better understood, and the loss 
of life comparatively small to what it was in former years. 
Yet it is a disease of that insidious nature, which almost 
precludes the possibility of methodically drawing a mathe- 
matical line of practice in every stage. So treacherous, 
so various are the features and symptoms in different 
patients from first to last, that nothing but acquaintance 
with this foe to mankind will enable a practitioner to com- 
bat its formidable attacks upon the constitution with any 
degree of success. And here let me offer a warning 
voice, which I do in the heartfelt sincerity of truth — never, 
never, let me implore of those who may embark in prac- 

* We no longer hear of bark -jackets, antiseptic baths, and port wine. 



56 



BILIOUS REMITTENT FEVER. 



tice where this disease is to be found, adopt a line of prac- 
tice which may have no further claim upon your mind than 
the novelty of fashion ! 

In the first stage the principal object seems to be best 
directed to diminish the phlogistic diathesis by suitable 
means 3 adapted to the age and sex, idiosyncrasy and tem- 
perament. It is in the first stage that the greatest 
promptness, the greatest caution, become requisite in em- 
ploying or carrying to excess (or erring in the other ex- 
treme) any measures as general evacuations, &c, some 
patients bearing topical better than general. Endeavour 
as soon as possible to check vomiting ; it is of impor- 
tance, as I have before premised, to keep the thermal state 
below 105° if possible ; the liberal, but not prodigal em- 
ployment of cathartics, enemata, effervescing draughts, &c. 
In the two succeeding stages the affections of the stomach 
and the head demand particular attention. If, as is before 
observed, a remission takes place in eighteen hours, the 
attack may be looked upon as mild, if you have not great 
exhalation of heat ; take advantage, therefore, of natures 
index, and adopt proper remedies, which have already 
been noticed. It may be otherwise, as the second stage 
is often ushered in by an increase of the febrile symptoms, 
with more or less pain at the pit of the stomach, oppres- 
sion, &c. &e. Persevere steadily with cathartics, miti- 
gate the external heat by sponging affusion, and let not 
the most trifling symptom be unattended to. 

In the third stage, if the disease is to terminate fatally, 
and as the symptoms which characterise this stage have 
been already carefully and faithfully detailed, little re- 
mains to be done; still, however, do not despair; there 
have been, and I have witnessed, astonishing recoveries, 
when all hope had fled. See Cases. 



BILIOUS REMITTENT FEVER. 



57 



During the whole period of treatment the strictest at- 
tention to the antiphlogistic diet is required : the digestive 
powers seem to be totally suspended ; the stomach is at 
least incapable of receiving any food ; and therefore total 
abstinence is enjoined, or the lightest food, with subacid 
fruits, such as the orange, can only be given, until signs 
of the recovery of the stomach occur; and then the 
patient should be very guarded in his wants. During 
convalescence great debility occurs, and the functions re- 
turn to the normal (natural) state very slowly. 

In this period, therefore, great attention must be paid 
to regulate all the functions properly, especially the di- 
gestive organs, and to increase by light and nutritious 
diet, and the cautious use of tonic and stimulant reme- 
dies, the strength of the system gradually. 

The recovery is more rapid when patients are removed 
to a higher and drier atmosphere ; and still more rapid 
when they are sent to a distant or colder climate. 

PROPHYLAXIS. 

As this disease has often made great havoc amongst 
mankind, means have been anxiously sought after to pre- 
vent its origin, its attack, and progress. 

As it most commonly arises in tropical climates from the 
presence of a miasmatous atmosphere, this can only be re- 
moved in part by draining and opening the country, which 
will at least meliorate such an atmosphere. 

We are told that fumigations have been employed with 
great success in the epidemic yellow fever of Spain. Mr. 
Gimbernat, under- director of the Natural History Museum, 
Madrid, published a memoir on the employment of acid 
fumigations during the epidemic in Andalusia in 1800. 



58 



BILIOUS REMITTENT FEVER. 



He used the muriatic acid fumigations in places not in- 
habitated, and the nitric in those that were inhabited. 

A very remarkable instance is mentioned of the efficacy 
of these in the town of Seville. 

In one suburb of this town the disease had existed for 
a month ; 1544 had been seized, of whom 509 died. 

The numbers of infected had increased every instant, 
and at least six or seven died every day. From the time 
that the fumigations were applied, no person was affected, 
and they all recovered to whom the nitric acid fumigations 
were applied, except one !" 

Fumigations are unquestionably proper, and ought not 
to be neglected, where there is the least suspicion of in- 
fection. But such broad assertions as M. Gimbernat's 
seldom obtain credit, and perhaps may be the cause of a 
valuable mode of practice being rejected. 

As it is impossible to correct a miasmatous atmosphere, it 
is necessary to remove from it as soon as possible. 

But as this fever, which is indigenous, and still visits 
districts in this island every year, from July to October 
particularly, the only chance of avoiding an attack ap- 
pears to be by an early removal to the high mountain re- 
sidences of the interior. 

If it is true, as has been remarked, that the Salentini 
were freed from pestiferous exhalations and diseases by 
rivers passing through their marshes, it would be advisable 
to follow such steps wherever practicable. I, however, 
entertain my doubts on this subject. There are instances 
to the contrary in the parishes of Portland and St. Thomas 
in the East. 

The atmosphere of marshy tropical countries is supposed 
not to possess a sufficient quantity of oxygen, and more 
particularly in the autumnal months than at any other 



BILIOUS REMITTENT FEVER. 



59 



period of the year. Every practicable means should then 
be employed to bring about a new supply, or to adopt 
such means as would prevent the absorption of the oxygen 
or decomposition of the pure state of the atmospheric air 
by a mixture of poisonous gases, from whatever cause. 

An intelligent author says that these putrid miasms, be- 
sides having a sedative action on the cerebral system, may 
yet have the property of decomposing the atmosphere, 
and of breaking the connexion of its two constituent 
parts ; for it may readily happen that these putrid miasms, 
being of an azotic mixture, may attract oxygen, absorb 
part, and consequently deprive the atmosphere of it. 

In this state it is impossible it can any longer produce 
the salutary effects of wholesome respiration ; whatever 
it may be, both causes always produce the same effects, 
nervous debility or collapsus — results which we too often 
witness in this disease. 

I once thought that the aggravated ardent bilious re- 
mittent fever of this country might become infectious, 
where a great crowd of sick are huddled together ; and 
more especially if cleanliness and great attention to the 
sick are neglected to be most sedulously performed ; but I 
have witnessed scenes of disease nursed in the lap of 
filth, (which I am happy to say is of rare occurrence in 
this country,) that my heart sickens to retrace my steps 
back to the spot. 

I cannot now say that in these instances, although in 
a crowded part of the town, amongst the poor of all co- 
lours, ages, and sexes, any infection spread, but the 
disease, autumnal bilious remittent, was clearly and satis- 
factorily accounted for from the immediate locality of 
marsh effluvia, acting upon subjects predisposed from their 
habits and drunkenness, &c. 



60 



BILIOUS REMITTENT FEVER. 



" And fell miasma's suffocating breath 
Fill'd the dank pinion of the air with death." 

Every experiment that has been tried to destroy this 
airy hydra appears to have effected little. When this 
shall be finally established, the prophylaxis will be com- 
plete. 

The following cautions are not inapplicable to the pre. 
sent subject. 

As strangers are most liable to be affected with this 
disease on coming into tropical climates, the greatest pre- 
cautions ought to be taken by them until they are sea- 
soned, or become acclimates, as the French call it ; for 
there can be no doubt that the ravages which this fever 
has made amongst troops and individuals has arisen, 
for the most part, from their own imprudence ; by too 
freely exposing themselves to the night air, walking in the 
heat of the sun, intemperance in eating and drinking, bad 
spirituous liquors, too free an indulgence in fruits and 
other luxuries. But by a proper attention to diet, regimen, 
state of the bowels, clothing, flannel next the skin, until 
the constitution has become assimilated to the climate, the 
risk of an attack of this disease is very much diminished. 
Too much attention to these circumstances cannot be 
paid, for the preservation of the troops on their arrival in 
tropical climates. 



CONCLUDING OBSERVATIONS. 

Before quitting this interesting subject, the following ob- 
servations may be made. 

First: — The discordant opinions of physicians cannot 
easily be accounted for nor reconciled with our present 



BILIOUS REMITTENT FEVER. 



61 



knowledge of this disease. Not that I think they have 
seen different diseases, but different forms of the same 
disease, varying according to the exciting causes, habit of 
the patient, station, country, temperature, season, and 
many collateral circumstances, and, above all, the severity 
of the attack which produces such a different train of 
symptoms, and of course a diversity of practice. 

Second : — It is an endemic disease in tropical climates ; 
but why it is more common in the West than in the East 
has not been ascertained ; although I believe it is exceed- 
ingly prevalent on the marshy banks of the Ganges. 

It is seldom sporadic, except when it bears all the marks, 
symptoms, and causes of feb. continua which characterises 
sporadic fevers. 

Third: — It varies from a state of the atmosphere ap- 
proaching to miasmatous, or from the same cause which 
produces feb. intermittent and feb. remittent. Lind's ob- 
servations on this head are conclusive. 

Fourth : — It is said " that under certain circumstances 
this disease becomes contagious, and the contagion is spe- 
cific ; id est, it produces a disease different from other dis- 
eases, and to have its own peculiar laws." 

This I cannot persuade myself to believe. At what 
period is it contagious ? I have never witnessed a case 
produced by what is called the specific action of conta- 
gion. It may have its own peculiar laws regulated by 
a variety of circumstances, but still it is manifest that 
the disease is yellow remittent fever. 

The causes, exclusive of contagion, exist to such an ex- 
tent, and so permanently, that probably the loss of human 
life occasioned by it exceeds that of almost all other dis- 
eases. 



62 



BILIOUS REMITTENT FEVER. 



If contagion is a quality which belongs to it, it ought 
to manifest its activity in circumstances favourable to, and 
upon all individuals susceptible of its action. Let us at- 
tend to this great fundamental truth, viz. that no disease 
is ever contagious unless it has originated from conta- 
gion, and that contagious diseases can only be produced 
by their respective contagions. 

Let me remark the case of a young man who was at- 
tacked with this fever in the most aggravated form ; the 
duration of the disease only 108 hours ; it was the most 
malignant case I ever witnessed. Being a young man of 
great promise and large fortune, the greatest solicitude was 
shown to him by his friends and domestics, who never 
left his room night or day ; some remained till the corpse 
was removed to the place of interment, which was in a 
state of decomposition. No case of fever followed in any 
of his attendants. I could multiply similar cases, if it 
were necessary. I have dissected many bodies at various 
periods after death. Dr. Fordyce has told the world that 
all fevers are contagious, as the symptoms are more violent. 
God help us if this were the case ! 

Fifth: — It is said that, like the contagion of the exan- 
themata, it attacks a person only once in his life. 

It will attack a person several times in his life. I have 
myself suffered severely from three aggravated attacks of 
this disease, and I could generalize this remark by men- 
tioning many living witnesses. 

I believe the predisposition can never be annihilated, so 
long as the individual resides within the pale of such 
causes as produce it. 

Sixth: — It is asserted, " that its specific action pro- 
duces febrile symptoms, accompanied with a peculiar 



BILIOUS REMITTENT FEVER. 



<33 



affection of the skin and of the stomach." " In its action it 
bears the greatest analogy to the action of the contagion of 
the continued fevers of cold countries." 

It is, in my opinion, doubtful whether any fever exists 
in cold climates originally contagious. They may be- 
come so in the latter stages, when nature and the whole 
economy of the system is overcome by disease, or inca- 
pable of withstanding its force in consequence of previous 
debility. In what is called typhus gravior, does not the 
onset of the disease rather denote feb. continua ? 

Seventh : — It is said that this disease assumes various 
types, as that of continued fever of the inflammatory 
type. Hence the denomination of Dr. Moseley, causus 
tropicus ; typhus icterodes by Sauvage ; feb. continua pu- 
trida, Macbride, &c. 

This variety of synonima has been handed down to us 
by the ancients, and the modems have continued them 
with scrupulous nicety to the present day ; an error not 
only as regards this, but other diseases. 

Cullen, in speaking of pneumonia, evidently thought 
pneumonia and pleuritis one disease. The ancients made 
two genera of the inflammation of the thorax. Cullen 
considered the spurious peripneumonia to differ from the 
true only in degree; at any rate it ought not to have 
any weight with us in practice. 

Eighth : — Is it possible to reconcile the following ob- 
servations ? 

" This fever is characterised by no particular symptom, 
except yellowness of the skin and black vomit." 

These symptoms, yellowness of the skin and black 
vomit, are not, as I have previously remarked, always 
present, even in fatal cases. One or both frequently attend, 
but oftentimes both are wanting. I have unquestionable 



64 



BILIOUS REMITTENT FEVER. 



authority for saying that, in a certain epidemic, almost all 
the fatal cases were unattended with black vomit. I, 
however, consider that, in the absence of both those symp- 
toms, the cases will terminate favourably. 

According to Humboldt, the vomito prieto, or black 
vomit, had long prevailed at Vera Cruz. It is certain that 
the vomito, which is endemical at Vera Cruz, Cartha- 
gena, and the Havannah, is the same disease with the 
yellow fever, which since the year 1793 has never ceased 
to afflict the inhabitants of the United States and the 
West Indies. 

It is not decided whether this fever is perceptible in 
the Causus of Hippocrates, which is followed, like bilious 
remittent fevers, by a vomiting of blackish matter; but it is 
thought that the yellow fever has been sporadical in the 
two continents, since men born under a cold zone have 
exposed themselves in the low regions of the torrid zone 
to an air infected with miasmata. 

Wherever the exciting causes and the irritability of the 
organs are the same, the disorders which originate from a 
disturbance in the vital functions ought to assume the 
same appearances. 

It is not to be wondered at, that at a period when the 
communications between the old and the new continents 
were more numerous, and when the number of Europeans 
who annually frequented the West Indian islands was 
still smaller, a disease which only attacks the individuals 
not seasoned to the climate should have very little engaged 
the attention of the physicians of Europe. In the six- 
teenth and seventeenth centuries the mortality could 
not have been great, because the equinoctial regions of 
America were only visited by Spaniards and Portuguese ; 
their manners, habits, temperaments, are all essentially 



BILIOUS REMITTENT FEVER. 



65 



different from the English, Danes, and other northern in- 
habitants of Europe. 2ndly. The populous cities of Cuba, 
Jamaica, and Haiti, were not built ; and 3rdly. The 
Spaniards were seldom attracted towards the sea-shore, on 
account of the great heat and humidity, preferring the 
elevated table-lands of the interior. 

It cannot be denied, from the facts related by Sydenham 
and other excellent observers, that, under certain circum- 
stances, germs of new diseases may be developed ; but 
there is nothing to prove that the yellow fever has not 
existed for several centuries in the equinoctial regions. 

The oldest description of the yellow fever is that of the 
Portuguese physician, Joam Ferreyra da Rosa, who pub- 
lished a treatise at Lisbon, 1694, under the title " Trattado 
da Constituicam Pestilencial de Pernambuco." He ob- 
served the epidemic which prevailed at Olinda, in Brazil, 
between 1687 and 1694, shortly after a Portuguese army 
had made the conquest of Pernambuco. 

According to the opinion of people of the country, the 
vomito prieto, or yellow fever, was unknown at St. Martha 
and Carthagena before 1729, and at Carthagena previous 
to 1740. Juan Josef de Gastelbondo described the first 
epidemic at St. Martha, Lururiaga de la calentura biliosa. 

A feeble analogy is discoverable in the pernicious in- 
termittent fevers which prevail in Italy, and which have 
been described by Lancisi Torti. Individuals have been 
known to die with nearly all the pathognomical signs of 
the ardent bilious remittent fever of Jamaica, such as 
yellow suffusion, bilious vomitings, and haemorrhages. 

It is confidently asserted by that enlightened traveller 
Humboldt, that the yellow fever has never appeared hitherto 
on the western coast of New Spain. The inhabitants of the 
coast, which extends from the mouth of the Rio Papagallo, 

F 



66 



BILIOUS REMITTENT FEVER. 



by Zacatula and Colima, to San Bias, are subject to gastric 
fevers, which frequently degenerate into adynamical 
fevers ; and, in fact, you see none but bilious constitutions 
inhabiting those arid and burning plains, which are inter- 
sected with small marshes. I, however, reverence with 
deferential respect the assertions and opinions of such a 
man ; but I am credibly informed by several intelligent 
persons, that a fever exactly resembling our bilious remit- 
tent fever is endemical at San Bias, and almost the whole 
line of coast to the southward. One gentleman, in parti- 
cular, who trades to those shores from Jamaica, (Mr. 
Shepherd,) is not unfrequently called upon to exercise the 
functions of physician to the inhabitants — Spaniards, 
French, and Indians: and he has, although not of the 
profession, obtained a degree of celebrity which some of 
our very learned members of the faculty might envy. 

In the months of July, August, and September, the heat 
is excessive, and the mortality is great; the seamen from 
Europe and America suffer in the greatest proportion. 
This is not to be wondered at, as medical advice is rarely 
if ever obtained, except by the accidental appearance of 
a British cruiser, the surgeon whereof never fails to render 
eveiy assistance in his power. 

Ninth. — {Conclusion.) — With respect to the discord 
about the treatment of this disease, which so much per- 
plexed me years ago, and as regards the difference of 
treatment in the present day, it is impossible to reconcile it 
in any other way than by supposing that different diseases 
have been treated of by authors ; or that the same disease 
has been viewed differently at various stations, periods, 
and seasons of the years. The treatment, however, must 
always be diversified according to the habit of the patient — 
the length of time he has been in a tropical climate — tern- 



BILIOUS REMITTENT FEVER. 67 

perature— age, &c. &c— the nature and severity of the 
attack. I believe blood-letting has been the principal 
point in discussion amongst those who have written on 
this disease ; both parties are, in some degree, justifiable 
in their assertions. The plethoric new-comer will gene- 
rally require abstraction of blood ; he comes to you 
charged with rich blood, high repletion, and no prepara- 
tion, whilst those assimilated to the climate, or who 
have previously suffered from its influence, do not require 
venesection. 

It must be presumed that authors who bestow such un- 
bounded praise on venesection in the treatment of this 
fever, have formed their opinions in consequence of having 
seen its good effects in the former class of patients, whose 
constitutions and habits were unassimilated to a tropical 
climate. And although it is, at certain periods, a parti- 
cularly fatal disease, it will yield to proper remedies and 
experienced treatment, if seen in its onset, (invasion, as 
Jackson calls it,) and the moral habits of the patient are 
not to be questioned. 



f 2 



68 



KILIOUS REMITTENT FEVER. 



APHORISMS. 



I. If you are a disciple of the Jackson school, look at 
your patient well, and estimate justly between the symp- 
toms which indicate, and the symptoms which contra- 
indicate, blood-letting. Study Van Rotterdam's work on 
the subject. 

II. Remember that no two patients are exactly alike. 
Beware how you use the lancet with female children, girls 
under twenty years of age, who have, and girls who have 
not, menstruated. 

III. If, as in private practice in families, your patient 
is of this class, do nothing until you have received from her 
mother, or her nurse, every particular concerning her pre- 
vious state — when the monthly secretion may be expected 
— the habitual state of her bowels ; examine well her 
temperament — her idiosyncrasy. With this knowledge 
obtained, 

IV. I caution you, as you value peace of mind, never 
bleed a girl when she is menstruating — it will be her 
death. 

V. And so with females who have been mothers. 

VI. It often happens that patients of this class will, in 



BILIOUS REMITTENT FEVEK. 



69 



the first or second stage, discover that this secretion has 
suddenly come on ; and I verily believe it is often hurried, 
and more profuse, in consequence of the fever. 

VII. This opinion is well founded; great experience 
has informed me of the consequent danger in bleeding a 
patient so circumstanced. 

VIII. This class of patients requires very great attention, 
and very careful treatment. 

IX. Be careful, too, how you deal with mercury in 
large doses, or drastic purgatives of any description. 

X. Direct all your energy to the treatment during the 
first eighteen or twenty-four hours — this is the precious 
period. Patients of this class will often tell you, when 
they are sensible in the first remission, that they are 
very well. Believe none of them — it is morally and phy- 
sically impossible. Supineness on the part of the medical 
attendant, at this moment, is fatal to the patient ; make 
as much of the remission, by giving appropriate remedies 
to lengthen it ; if you can establish a remission of six 
or eight hours, you will be amply compensated in your 
own mind. 

XI. Never give an emetic to male or female, if the 
fever has established its hold for a few hours; you are 
seldom called before it has — very often you will have to 
regret your being called too late. 

XII. To children, if early seen after the attack, it will 
be prudent to give a gentle emetic — ipecacuanha ; they 
cannot bear antimony. I have known death to follow 
from two grains of tartar emetic, although given in divided 
doses. 

XIII. Of anti-emetics, the most useful to males and 
females is the decoction of adru — (See p. 46.) 



70 



BILIOUS REMITTENT FEVER. 



XIV. Supposing the stomach is inclined to irritability, 
give it small doses. 

XV. Of opium I am very guarded. 

XVI. Morphias is a better preparation ; it has not the 
great disadvantage of causing constipation, which opium 
has. 

XVII. The solution of argentum nitrati acts better as an 
anti-emetic with females than with any other class of 
patients ; and as they are frequently fastidious about the 
taste of physic, this remedy is probably the least obnoxious 
which you can offer. 

XVIII. Cold affusion is the most important of all our 
remedies. If very cold or ice water is selected, before any 
other part of the body is touched, immerse the hands for a 
few minutes ; after this, you may sponge any part of the 
body with impunity, than which nothing is more grateful 
to the patient. They shudder terribly if you apply it be- 
fore the precaution of bathing the hands. 

XIX. I have frequently remarked, that occasionally 
bathing the hands and face relieves the very great thirst 
which too often prevails during the whole course of 
this fever. 

XX. Tonics and stimulants. It requires great dis- 
crimination when to hit upon the exact moment to call 
these powerful auxiliaries to our aid. 

XXI. The danger of neglecting them is great. Good 
hock is one of the safest and best. Quinine, the muriate, 
is invaluable. Antiseptics I consider but feeble means : 
when they appear to be called for, the patient's fate is 
generally sealed. 

XXII. Never, never, let me implore all those who 
may embark in practice, where this disease is to be found? 



BILIOUS REMITTENT FEVER. 



71 



adopt a line of practice which may have no further 
claim upon your mind than the novelty of fashion. 

XXIII. No person skilled in the treatment of this 
disease will bleed an old resident ; such a mode of prac- 
tice would prove highly injurious. 



72 



BILIOUS REMITTENT FEVER, 



ON THE TEMPERATURE OF THE 
SYSTEM. 



The phenomena of fever, whether ascribed justly to the mor- 
bific matter introduced into or generated in the system, or 
whether caused by lentor or viscidity of the blood obstruct- 
ing the circulation in the capillaries, and that the increased 
action was an effort of nature to overcome this obstruc- 
tion ; or whether inflammation of some particular organ or 
set of organs in the body produce all fevers ; or the de- 
rangements in the nervous system ; or that critical evacua- 
tions were prevented by the spasm of the extremities of 
the nerves ; or that the late John Brown's theory, that all 
diseases to which the human body is liable, arise from the 
principle of excitability being above or below the line of 
demarcation ; or that Darwin's sensorial fluid, secreted 
from the blood and accumulated in the brain, from which, 
as a fountain, it was sent to all parts of the body ; and 
that this fluid was, in different ways, liable to be ex- 
hausted, or accumulated : or if he was correct in ascribing 
the heat of fever to the inordinate action of this sensorial 
power accumulated to excess ; or whether the remote 
causes are certain sedative powers applied to the nervous 



BILIOUS REMITTENT FEVER. 



73 



system, which, diminishing the energy of the brain, pro- 
duces a debility in the whole functions ; — is or is not the 
remote cause of fever ; or who is right amongst all these 
speculative philosophers ; is not my purpose here to in- 
quire. Dr. Alison, in his able work on Pathology, 
p. 483, says, " Fevers sometimes terminate fatally, without 
any satisfactory evidence appearing, on dissection, of in- 
flammation of any part of the body ; and very generally 
with so slight appearances of that kind, as are inadequate 
to the explanation of the fatal event." This I have more 
than once perceived. 

My present remarks will be — 

On the temperature of the system in the febrile dis- 
eases of Jamaica, but more particularly in the bilious re- 
mittent fever ; and what is the limit in the thermal scale 
to which the heat can arrive without endangering life. 

In arranging the first class of fevers, which frequently 
occur, although they "may differ in the number and 
variety of their symptoms," I shall consider them as dis- 
eases which have the characteristic symptoms of pyrexia, 
independent of any topical affection. The first of these 
febrile affections are bilious remittents, more or less 
acute, occurring at different seasons of the year, invad- 
ing different subjects, such as the European, the mixed, 
coloured, and negro races. The temperaments of these 
races are all essentially different, varying according to 
their respective ages and sexes. 

The second class must be enumerated under the head 
of intermittents, which are very prevalent, frequently 
obstinate, and run into a variety of forms, as simple and 
double tertian, quartan and quotidian. 

The next, are those partaking of the typhoid character- 
strictly speaking, in this climate, nervous fevers. This 



74 



BILIOUS REMITTENT FEVER. 



class is chiefly confined to females. I have witnessed 
it in males, but not often. These I shall consider as the 
leading diseases to which the subject more immediately 
applies, as it will form a reference to the foregoing trea- 
tise on the yellow bilious remittent fever. The tempera- 
ture of the system, in the orders phlegmasia^, exanthe- 
mata, haemorragise, and profluvia, I shall not be so 
minute in detailing, as they all, more or less, depend upon 
a disturbance in some particular place, external or in- 
ternal, having the part injured. / believe there is no 
study more calculated to improve the healing art, or to 
throw more light on the nature of febrile diseases, than 
a minute attention to the state of the temperature of the 
system. That the temperature of the system, when at- 
tacked by these diseases, depends much upon circum- 
stances, such as idiosyncrasy and season, admits of no 
doubt ; these diseases vary in degree of virulence (as I 
have already remarked) at different periods of the year, 
sometimes connected with the changes of the atmosphere. 

From May to the end of June, the fevers are more acute, 
and of consequence the temperature of the system will be 
increased. 

From July to the end of October, the febrile diseases 
assume a more formidable character, are more regular and 
frequent in their attack, more serious, more malignant, 
and much more fatal, than at any other period of the 
year. 

From this period until the end of the year, a fever of a 
milder form assails the inhabitants, such as fever of the 
intermittent type, but, as regards the temperature of the 
system, equally interesting. 

Sydenham remarks, " I do not at all deny that there 
may be diseases of every hour, but there doubtless are 



BILIOUS REMITTENT FEVER. 



75 



some which observe the seasons as regularly as certain 
birds or certain plants." 

Having kept an exact register of the temperature of the 
atmosphere for twenty-five years, I shall give the mean 
average of those years as a guide. It is as follows : — 
From January to March, which I call the first quarter. 
From April to June, the second. 
From July to September, the third. 
From October to December, the last. 
In the first, the altitude of the mercury, before the sun 
has any influence upon this part of our planet, according 
to Fahrenheit's scale, will be 70°, the greatest altitude dur- 
ing the day 80°. 

In the second 70° a.m. 80° p.m. 

In the third 75° 85° 

In the fourth 74° 84° 

Extreme solar heat in the first, taken at various times 
in each month 100°. 

Of the second . . 110° 
Of the third . . 125° 

Of the fourth . . 100° 
In the months of August and September, in particular 
years, the solar heat was often as follows : — 

In the year 1819 the maximum was 130° 
Do. 1820 . . . 125° 
Do. 1823 . . . 130° 
Do. 1825 . . . 130° 
Do. 1827 . . . 125° 
Do. 1828 . . . 125° 
In the year 1825 the heat was oppressive, particularly 
in the lower town ; the mercury in the shade was 93° for 
several days in the month of August. A casual glance at 
the above would induce any person to believe that a tern- 



76 



BILIOUS REMITTENT FEVER. 



perature of atmosphere equal to the above must be intolera- 
ble to all classes of the inhabitants ; and so it would be, 
if the prevailing winds were not constituted as they are, 
to make this heat less inconvenient than might be 
imagined : for instance, in almost all parts of the island 
a cool land-wind rushes down from the mountains into the 
plains, at an early hour in the evening, and prevails dur- 
ing a great part of the year every night, and continues 
until about eight or nine o'clock in the morning ; it is 
then succeeded by what is called the trade or sea-breeze, 
which is uniform and constant until sunset. 

Before touching upon the temperature of the system 
in a state of disease, the following experiments were 
made to show the temperature of the system in health. 

The experiments were made upon every denomina- 
tion of subject, at different periods of the year, at different 
times of the day, and under a great variety of circum- 
stances. 

There are generally one or two degrees of heat between 
the experiments under the tongue and in the axilla, which 
was always found the lowest in those subjects who sub- 
mitted to the trial ; some from fear, and others from deli- 
cacy, objected to the exposure. Creole or European 
ladies, and females of the highest castes, were not solicited 
to this part of the experiments. 

I selected for the following experiment ten healthy Creole 
black labourers, whose ordinary work consisted in tilling the 
soil, planting canes, and a variety of other kinds of plan- 
tation duty. They are generally employed at stated 
hours, commencing at daylight; they work until half- 
past eight or nine o'clock, at which time they enjoy a 
hearty breakfast; they resume this occupation as soon 
as this meal is over, and continue at work until half- 



BILIOUS REMITTENT FEVER. 



77 



past twelve ; one hour and a half is then allowed as a 
respite, and to take their dinner if they like it, but which 
is rarely done, — preferring, as they do, to close the 
labours of the day at their own houses over a substantial 
meal ; consequently at two o'clock all hands are again at 
their posts ; and such is the light-heartedness of these 
people, that a person passing by would suppose, and with 
very good reason too, some convivial scene was acting — so 
joyous the song, so cheerful the chorus. At sunset the 
work of the day is done. It is no uncommon sight at this 
time to witness the various groups quitting the fields, 
singing and dancing with manifest delight. 



EXPERIMENT FIRST. 



No. 


Age. 


Temp, under 
the tongue. 


Remarks. 


1 


28 


90° 


Healthy, muscular, skin cool. 


2 


28 


98° 


The same, cool. 


3 


27 


28° 


Ditto. 


4 


25 


98° 


Ditto. 


5 


24 


98° 50 


Active, spare habit. 


6 


24 


96° 


Ditto, cool. 


7 


24 


97° 


Thickset, muscular, very active, & skin cool. 


8 


22 


99° 


Short, athletic. 


9 


22 


98° 


Active, spare habit. 


10 


22 


99° 


Ditto. 



EXPERIMENT SECOND. 

The same subjects, in the afternoon, time four o'clock, 



78 BILIOUS REMITTENT FEVER. 

temperature of the atmosphere 83° ; had been at work in 
the field all day. 



No. 


Age. 


Temp, under 
the tongue. 


Remarks. 


1 


28 


99° 


Skin cool and perspiring. 


2 


28 


99° 


Ditto. 


3 


27 


98° 


Ditto. 


4 


25 


99° 


Skin cool, less perspiration. 


5 


24 


98° 


Ditto. 


6 


24 


99° 


Ditto. 


7 


24 


99° 


Ditto. 


8 


22 


99° 


Copious perspiration, cool. 


9 


22 


99° 


Cool, less perspiration. 


10 


22 


99° 50' 


Cool. 



The above subjects appeared cheerful, and quite the re- 
verse of suffering from the toil of the day. They were far 
from being fatigued or oppressed by the heat of the sun. 
They worked, for the most part of the day, without their 
shirts ; yet, notwithstanding the action of the sun upon 
their uncovered shoulders, to the touch their skins were 
perfectly cool, as well as their inward sensations, which 
they declared to be free from preternatural heat. 



EXPERIMENT THIRD. 



Ten black Creole domestics, accustomed to light work 
in the house, and seldom exposed to the sun. Time, seven 
o'clock a.m., before breakfast ; temperature of atmosphere 
70°. 



BILIOUS REMITTENT FEVER. 



79 



No. 


Age. 


Temp, under 
the tongue. 


Remarks. 


1 


25 


98° 


Healthy, spare habits, sober young man, 


2 


24 


97° 


Ditto. 


3 


19 


98° 


Ditto. 


4 


19 


97° 


Ditto. 


5 


12 


99° 


Stout, healthy boy. 


6 


12 


96° 


Thin, active girl. 


7 


11 


98° 


Stout, thickset girl. 


8 


11 


99° 


Spare habits, boy. 


9 


10 


98° 


Ditto. 


10 


10 


98° 


Ditto. 



The above subjects were tried several times, and the 
results averaged exactly as set forth. It may be worthy of 
remark, that their manners and customs approximated to 
the higher caste of servants, who feed nearly as well as 
their European or native masters and mistresses ; they are 
never hard worked, and seldom exposed to the vicissitudes 
of the weather. 



EXPERIMENT FOURTH. 

Ten labourers employed in field-work, on a plantation 
nearly on a level with the sea, all Creoles, and born on the 
estate ; all remarkably healthy subjects. They had been 
actively engaged from eight o'clock until noon. 

The solar heat was 108°. Thermometer, in the shade, 
81°. Time, one o'clock, April 9th. 

No- Age. T -P;-t Be™** 

Stout, muscular man, not much perspiration. 
Ditto, rather more perspiration. 
Ditto, perspiration about the head and neck. 



1 


35 


99° 


2 


32 


99° 


3 


30 


98° 



so 



BILIOUS REMITTENT FEVER. 



4 


30 


99° 


Ditto, sensation cool. 


5 


30 


99° 50' 


Ditto. 


6 


25 


99° 


Ditto. 


7 


23 


99° 


J Spare habit, active, skin rather warm, 


( sensation cool. 


8 


22 


99° 


Ditto, skin cool. 


9 


20 


99° 


{ Stout, active, short stature, deaf and dumb, 
i£ but a cheerful, well-disposed young man. 


10 


20 


99° 


Stout, active young man. 



EXPERIMENT FIFTH. 

Ten subjects, all healthy, employed at various trades 
on a large plantation near the town. The carpenters' work 
is generally laborious, particularly in the operation of 
squaring very hard timber for mills, &c. They are ex- 
posed to the sun, while at work with their axes, which 
they use with the greatest nicety and skill. Temperature of 
atmosphere 84°. Solar heat 125°. Time, two o'clock p. m., 
August 14th, 1825. 



No. 


Age. 


Temp, under 
the tongue. 


Remarks. 


1 


32 


99° 


S Carpenter, active, well made, 4 ft. 10 in., 
£ cool. 


2 


31 


99° 


Ditto. 


3 


. 30 


98° 50' 


Cooper, stout, chubby fellow, cool, ditto. 


4 


30 


98° 


Ditto. 


5 


28 


99° 25' 


Carpenter, powerful young man, 6 ft., cool. 


6 


27 


99° 25' 


Carpenter, athletic young man. 


7 


27 


99° 50' 


f Blacksmith, employed at the forge ; given 


8 


( to tippling ; short, spare habit, half caste. 


26 


98° 


Employed in the distillery. 


9 


25 


99° 


Ditto. 


10 


25 


100° 


Ditto. 



BILIOUS REMITTENT FEVER. 



81 



EXPERIMENT SIXTH. 

Ten subjects, half-caste, in good circumstances, follow- 
ing no particular occupation or trade, seldom exposed to 
the sun, living in a fine cool atmosphere, at an elevation 
of fifteen hundred feet above the level of the sea. Mean 
temperature throughout the year 78° ; ten o'clock a. m. 



No. 


Age. 


Temp, under 
the tongue. 


Remarks. 


1 


18 


97° 


Female, delicate slim figure. 


2 


17 


97° 


Ditto, sister to the above. 


3 


17 


97° 50' 


Fat, chubby boy ; healthy, strong, 


4 


15 


98° 


Ditto. 


5 


Id 


97° 


Ditto. 


6 


14 


99° 


Delicate, slim figure, female. 


7 


13 


98° 


Girl, healthy, slim figure. 


8 


13 


97° 


Ditto. 


9 


isi 


96° 


Ditto. 


10 


10 


98° 


Active boy. 



EXPERIMENT SEVENTH. 

Ten subjects, all females, of higher caste ; complexion 
nearly white ; residing in the town ; of exceedingly indo^ 
lent habits ; very temperate, and seldom exposed to the 
sun. Chief employment, needlework. 

. Temp, under _ 
No - A S e - the tongue. Remarks. 

1 40 99° Healthy, thin, good figure, born in Kingston , 
l ftl QQO \ Dau g hter t0 the above, very fair, healthy, 

2 lo 2 I middle stature, fine figure. 

3 17 98° Sister to the above, healthy. 

G 



82 BILIOUS REMITTENT FEVER. 



4 


16 


99° 


Sister to the above, healthy. 


5 


14 


99° 


Fat, active girl, ditto. 


6 


32 


97° 


Female, healthy ; mother of several children. 


7 


30 


97° 


Healthy female. 


8 


16 


96° 


Active girl, employed as servant to a lady. 


9 


16 


97° 


Healthy, round, well-made figure. 


10 


16 


96° 50' 


Girl, healthy, stout figure. 



EXPERIMENT EIGHTH. 



Five subjects, third caste, born in the town. 

No. Age. T t hetong n ue e . r Remarks. 



1 


16| 


97° 


5 Active lad, employed as writing clerk to a 
I merchant. 


2 


16 


98° 


Short, active lad, employed as clerk. 


3 


15J 


99° 


Healthy, no employment. 


4 


22 


98° 


Small, well-made young man ; carpenter. 


5 


25 


98° 


Small, stout figure ; carpenter. 



EXPERIMENT NINTH. 

Six subjects, half-caste, following active employment, 
and much exposed to the vicissitudes of the weather : all 
males. 

No ' A S e * T tneL U gue! r Remarks. 

1 35 98° Healthy, carpenter. 

2 35 98° Ditto, mason. 



3 30 99° 



t Ditto, deputy to the sheriff of the district, 
( obliged to ride great distances. 

A QO QQO \ Yei 'y nealth y y° un S man > wri tin g clerk to 

4 oU Jo ^ several persons. 

* OR QQO $ Healthy young man, no fixed employ- 

D £o yy ^ ment, active and much exposed. 

6 25 99° Healthy young man, tailor 



BILIOUS REMITTENT FEVER, 



88 



EXPERIMENT TENTH. 



Ten subjects, all Europeans. Temperature of atmo- 
sphere 78°. Time eight o'clock a. m. 



Remarks. 

< Full liver, healthy •, resided in the country 
\ upwards of fourteen years. 
J Full liver, healthy ; ten years in the 
\ country. 

\ Planter, active and much exposed, mode- 
l rate liver ; ten years in the country. 
$ Planter, thin, active man ; eight years in 
\ the country ; lives freely. 
i Surgeon ; much exposed in his profes- 
s sional duty by frequent long rides on 
( horseback both by day and night. 
Resides in the town ; six years in the island, 
Pale face, delicate young man ; three years 
in the island. 



No. 


Age. 


Temp. 

the to: 


1 


40 


97° 


2 


38 


99° 


3 


36 


97° 


4 


32 


97° 


5 


30 


97° 


6 


26 


98° 


7 


21 


99° 


8 


17 


98° 


9 


17 


98° 


10 


17 


97° 



{ 

Active boy, clerk to the above. 
No employment. 
Ditto. 



EXPERIMENT ELEVENTH. 

The same subjects submitted to the experiments after 
breakfast. Time ten o'clock. Temperature of atmo- 
sphere 80°. 



No. 


Temp, 


1 


99° 


2 


99° 


3 


98° 


4 


98° 


5 


97° 


6 


98° 


7 


100° 



G 2 



84 



BILIOUS REMITTENT FEVER. 



8 98° 

9 98° 
10 98° 



EXPERIMENT TWELFTH. 



Six subjects, all Europeans, upwards of thirty years in 
the island : all very healthy ; at different times of the day, 
and at their own residences. 



-. fi Q qqq S Scotsman; hale, muscular man, very ac- 

1 OS yy DO £ tive, walks a great deal. 

2 67 99° Scotsman ; retired planter. 

^ 70 070 J Scotsman; retired, lives freely; active old 

o 7U 97 | man# 

A fin Qto J Scotsman ; fat, strong, and healthy ; lives 

4 DU y7 \ freely. 

^ an qco f Scotsman ; clumsy or corpulent, inactive ; 

° 0U y8 \ lives freely. 

s Scotsman ; lives in the interior, visits the 
6 56 98° y town occasionally ; habits very tempe- 

i rate ; rather infirm, and very thin. 



The foregoing experiments give the mean results as 
follows : 



Experiment. 


Number of 


Temp, under 


Subjects. 


the tongue. 


First 


ten 


97° 95' 


Second 


ten 


98° 85' 


Third 


ten 


97° 80' 


Fourth 


ten 


99° 85' 


Fifth 


ten 


97° 90' 


Sixth 


ten 


97° 45' 


Seventh 


ten 


97° 75' 


Eighth 


five 


98° 


Ninth 


six 


98° 50' 



BILIOUS REMITTENT FEVER. 



85 



Tenth ten 97° 9(V 

Eleventh ten 98° 30' 

Twelfth six 98° 8' 

The mean of the whole series, comprising 107 subjects, 
of all denominations, ages, and sexes, is 98*19-^, which 
may be considered a correct estimate of the temperature of 
the system in health, such as is enjoyed in a climate like 
Jamaica. I shall next point out the deviations which 
occur in consequence of febrile or preternatural heat, by 
a series of cases and observations, for the purposes con- 
templated in the inquiry, and I think it will be seen that the 
system is not capable of bearing any great augmentation 
of heat from morbid causes, without incurring serious, and 
sometimes irreparable, mischief. In fever, particularly of 
the remittent form, the whole power of the animal economy 
is deranged — all its healthy functions are suspended — 
digestion is but imperfectly performed — the mental energy 
is much weakened by the agent which causes the fever, 
the ardent heat, and rapid circulation ; the heart is labour- 
ing and appealing for relief — the whole system is screwed 
up, as it were, to its highest pitch of excitement. The 
heat, at this time, is at its utmost limit, and if continued 
for many hours, the extinction of life would, in all proba- 
bility, result, in consequence of various changes or de- 
compositions taking place in the blood. The exact degree 
of heat which is necessary to achieve this end, has hitherto 
not been very accurately ascertained ; it will require much 
diligent investigation to settle the point. The ingenious 
Dr. Hales believed " the heat of the blood in high fevers to 
be 136°." This is irreconcilable to anything I have wit- 
nessed during twenty-five years' practice. Boerhaave 
also made various experiments, and he seems to think that 



BILIOUS REMITTENT FEVER. 



<£ terrible mischievous work might be effected by a degree 
of heat above 106°," for, as he asserts, the serum of the 
blood would be coagulated. And he further asserts, that 
the natural heat of the blood of a human creature ap- 
proaches very near the degree of coagulation. Hippo- 
crates, 4 de Morb. 23, observes, 6i Such a degree of heat, if 
neglected or wrongly managed, may, indeed, dissipate the 
more thin and watery parts, and so gradually thicken the 
whole mass of blood ; have bad enough effects that way, if 
it do not bring on a putridinous thinness." This was 
evidently but supposition ; the serum of the blood, or the 
white of an egg, requires a degree of heat to coagulate, which 
no living animal can bear, notwithstanding the juggling 
tricks of fire-eaters and such mountebank impostors, who 
thrust themselves into ovens, heated sufficient to bake a 
leg of mutton. Water at 108° is too hot for the hands, for 
any length of time ; yet there are some persons who can 
bear water at 120, and there are persons, from custom, 
who can handle very hot pieces of iron ; but such instances 
are only sufficient to form an exception to the rule, and 
require no further comment. 

Of the preternatural or febrile heat, which is one of the 
most distressing symptoms of tropical fever, there are 
certain modifications, owing to a variety of circumstances, 
such as season, climate, age, sex, temperament. The 
theory of the sources of animal heat has been explained ; 
and if we could, upon the same rational principles, 
account for the phenomenon which produces the febrile 
heat, our practice in the cure of fevers would be much 
more simplified than it is at present. If we suppose 
that the introduction of morbific air into the lungs causes 
an increased momentum sufficient to disturb the healthy 
circulation, we only account for what absolutely appears 



BILIOUS REMITTENT FEVER. 87 

self-evident to our senses, without knowing what quantity, 
when, or where we take ; and, in fact, what is the peculiar 
state of the system, so as to allow the enemy to enter and 
keep so strong a hold of the citadel. 

There are many predisposing causes, and there are many 
temperaments, each having its own peculiar manner of 
adoption, for the reception of the febrile cause. If this 
febrile cause produces the excessive vascular action, may 
we not suppose that the increased momentum is the 
cause of the preternatural heat ? Let us examine the pre- 
disposing causes ; let us also examine the effects of ma- 
laria invading the different temperaments in the bilious 
remittent fever, for the purpose of ascertaining, in a satis- 
factory manner, the reason of its producing pyrexia, 
under the variety of forms we meet it during the year. 

It is admitted, that all ages are liable to it — women less 
so than men. Sanguine temperaments ; plethoric habits ; 
robust constitutions ; persons who live freely ; (spare 
habits are not exempt ;) the depressing passions of the 
mind; the timid, — and those who dread its attack; 
fatigue ; every species of intemperance ; great exposure 
to the sun, — to heat and moisture ; exposure to the chill- 
ing night air: these are all some of the predisposing 
causes. The exciting cause is limited to malaria. The 
predisposing causes are in constant operation, they must 
be met with at all times ; but the exciting cause differs 
in its degree of virulence at different periods of the year, 
according to local circumstances, and to a great variety 
of changes taking place in the component parts of the 
atmosphere. 

If, therefore, the malaria invades the different tem- 
peraments already acted upon by the predisposing causes, 
we need not wonder at beholding such a medley of 
symptoms. 



88 



BILIOUS REMITTENT FEVER. 



If, as I have before remarked, and which for the most 
part is perfectly consistent with truth, the febrile 
diseases are milder, and assail the different classes of in- 
habitants less severely from the month of January until 
April, it must be admitted, either that the exciting cause 
is less violent, or that the season is less favourable to 
produce the cause. 

It is true that the atmosphere, at this season, is cooler 
than at any other period of the year. We rarely meet 
with malignant fevers in these months ; there are excep- 
tions, but they are by no means general. The tem- 
perature of the system also is such, as to cause no 
apprehension for the safety of the patients. I will select 
four cases of different temperaments for the purpose of 
illustration. John Johnston, Englishman, aged 26, phleg- 
matic temperament, very healthy, complained on 8th 
April, 1824: griping, purging, and headache. On the 
10th, he had pains in the loins and extremities ; great 
thirst ; pyrexia ; temperature of skin during the paroxysm, 
104°; under the tongue, 105°. On the 11th he vomited 
much ; a pyrexia ; pulse 80° ; temperature under the 
tongue, 100°. In the afternoon of the 12th, pyrexia 
returned ; temperature during the paroxysm, which lasted 
six hours, 104°. Free from fever on the 13th ; on the 
14th he complained of pain on the chest; cough, pyrexia 
in the evening : this paroxysm lasted until the afternoon 
of the 15th, temperature of skin 104° ; temperature under 
the tongue, at eight, twelve, and two o'clock, as follows, 
105°, 105°, 105° 25'. At eight o'clock p. m., a pyrexia, 
and bathed in perspiration ; gradual convalescence fol- 
lowed. 

Daniel Shea, Irishman, sanguine temperament, aged 28, 
hitherto enjoyed good health ; attacked with the usual 
symptoms of pyrexia on the 19th April, 1825: tern- 



BILIOUS REMITTENT FEVER. 



89 



perature under the tongue, during the first paroxysm, 
105°. Second paroxysm on the 20th, temp. 105°. This 
paroxysm was severe ; great pain in epigastric region, 
affected his breathing during the night ; he was bled to 
twenty-four ounces : the heat remained undiminished ; 
was bled again on 21st. In the evening he was free from 
pain; pyrexia moderate; temperature 104°. On the 
22nd, pyrexia moderate ; pulse 110°, free from pain. 
23rd;, during the night he was attacked with severe pains 
in the left side of the thorax, which must have been spas- 
modic ; pulse 90° ; apyrexia : 24th, comparatively easy 
all day. No pyrexia from this period ; his convalescence 
was tedious, owing to ptyalism. 

George Thompson, Irishman, aged 29, eighteen months 
in the island ; cachectic habit, melancholic temperament ; 
not a very sober personage : complained, on the 3rd 
March, 1824, of lassitude, nausea, headache and weak- 
ness ; said he was in a party and drank more than usual 
last night; pulse 100°, small; tongue white and loaded; 
face, arms and body covered with lichen ; pyrexia : tem- 
perature under the tongue 104°. This paroxysm lasted 
sixteen hours ; left him nearly free from complaint, except 
debility. 

On the 7th, pyrexia again returned, with great rest- 
lessness and anxiety; pulse, small and rapid, 120°; 
temperature of skin 104° 25', under the tongue 106°. 
This paroxysm lasted all night. He had no return of 
febrile symptoms, and went into the interior of the country, 
where he gradually recovered his former health. 

Alexander Smith, Scotsman, aged 24, choleric, irritable, 
nervous temperament ; arrived in the month of December, 
1824, was attacked with fever the 10th March following ; 
he complained of pains on every part of the body, which he 



90 



BILIOUS REMITTENT FEVEE. 



attributed to exposure the night before : his face was con- 
siderably flushed ; the eyes watery ; tongue foul ; pulse 
100. At ten o'clock a. m., the skin was of the natural 
temperature, 97° ; the thermometer placed under the 
tongue marked only 98°. I ordered a warm bath and 
cathartic medicines. I did not see him until two o'clock 
the next day, as he lived seven miles from my residence. 
The pyrexia was considerable ; pulse 130 ; heat of skin 
104°; under the tongue, 106°; the paroxysm came on 
about eight o'clock, and lasted until midnight ; his irrita- 
bility was great, — he evinced the greatest impatience ; he 
was much alarmed ; at first he objected to the remedies, 
particularly the application of emplast. lyttae. ; but he at 
length yielded, and implored relief in any shape. 

About two hours after this paroxysm abated, he fell 
into a refreshing sleep. However, about six in the morn- 
ing he complained of a return of his former pains, and 
pyrexia succeeded. This paroxysm, which was severe, 
lasted only eight hours : the temperature at different times 
did not vary a degree, although the applications to the 
surface controlled the external heat ; the temperature of 
the system fluctuated between 105° and 106°. Having 
occasion to visit some other patients, I left him in the 
afternoon apparently easy. He had another paroxysm 
during the night, which was described to me as mild. A 
few days afterwards he went out for a change of air, and 
eventually recovered. 

My records furnish many cases of a similar nature. 
Although, as will be seen, the temperature did not differ 
more than one or two degrees in the different patients, yet, 
in all, the maximum heat was always observed in the 
second paroxysm to be the same. Johnston's temperature 
in the first paroxysm was 105° on the 14th : although 



BILIOUS REMITTENT FEVER. 



91 



his other symptoms were distressing, he felt no in- 
convenience from the heat, which was very little below 
Smith's or Thompson's, 105° 25' being the maximum. 
Shea's temperature was at its maximum a few hours after 
the onset of the first paroxysm ; it never rose higher ; he 
was freely bled. The second paroxysm on the 21st, in 
the evening of which day the temperature lowered one 
degree ; from this period the heat was moderate. 

Such cases as these are justly denominated mild; and 
as the fevers at this period of the year are, for the most 
part, uniformly so, we must conclude that the exciting- 
cause is less virulent, and consequently cannot produce 
fevers of so malignant a type as it does in other periods 
of the year, more particularly the autumnal months, as 
will be seen by the following extracts from cases : — 

July 11th. — William Wall, aged 20, an Englishman; 
sanguine temperament ; attacked yesterday, after a fit of 
intemperance, with the usual symptoms of ardent bilious 
remittent fever ; eyes red and watery ; skin dry and hot ; 
temperature 108°; pulse 110, full; tongue deeply coated 
with brown fur ; much thirst ; pains in the head, neck, 
back, and legs. Bled till he fainted, thirty ounces of blood 
taken ; constant cold applications ; retained all his me- 
dicine. 

12th. — Bowels free; no mitigation of the symptoms; 
continued the remedies as yesterday. 

13th. — Symptoms not so aggravated this morning ; pulse 
108 ; skin not so dry; trunk and extremities covered with 
lichen tropicus. 

14th. — Intense headache this morning ; oppression at the 
praecordia; pulse 100; watery stools. 

15th.— Violent pyrexia ; complains of his head ; shaved 
the head ; the coldest applications applied with great 



92 



BILIOUS REMITTENT FEVER. 



diligence, affording some relief; but in tlie afternoon he 
became delirious; tongue dry; thirst urgent; blister on 
the back of the head, neck, and between the shoulders, rose 
well ; free discharge. 

16th. — Passed a dreadful night ; pyrexia constant. 

17th. — Ditto, ditto; tongue dry, shrivelled, and brown ; 
pulse 120, small ; continued the cold applications ; stomach 
inclined to be irritable. 

18th. — Every symptom much aggravated; delirium; 
thirst urgent ; skin almost parching ; trunk and extremi- 
ties covered with purpura. 

19th. — The same; purpura more livid; vespere, de- 
bility almost to syncope. 

20th. — Moribund ; died at six o'clock. 

Remarks. — The temperature of the system of this 
patient varied in a very trifling degree from the first pa- 
roxysm ; it was 108° before the evening of the 11th, and 
it remained so during the greater part of the second pa- 
roxysm ; but on the 13th the skin became a little moist, and 
covered with lichen ; the remissions were very imperfect ; 
on the morning of the 15th, the temperature rose to 110°, 
and the symptoms became alarming. He was delirious all 
the 16th, 17th, and 18th ; the feel of the skin was peculiarly 
disagreeable. On the 19th the temperature sank to 100°; 
on the morning of the 20th the extremities were cold. 

In this case stimulants and wine were given early on 
the morning of the 19th, and he retained them, but it will 
be seen with what effect. 

July 16. — P. F , aged 26 ; attacked with aggra. 

vated symptoms of fever this morning ; he partakes of the 
sanguino-phlegmatic temperament; countenance ghastly 
and desponding ; violent headache and thirst ; tongue ash 
colour, loaded; pulse 120; skin hot and dry; tempera- 



BILIOUS REMITTENT FEVER. 



93 



ture under the tongue 108°, under the axilla 108°, external 
heat about a line less ; stomach easy. 

17th. — Pyrexia violent; great restlessness and anxiety ; 
pulse 1*20; temperature the same as yesterday. Vespere, 
bowels acting ; continue the remedies. 

18th. — General pains; headache; thirst; bowels free; 
several bilious evacuations ; stomach retentive ; head 
shaved ; cold applications to the head and body ; al- 
though zealously attended to, he experienced no relief. 

19th. — This morning he was free from headache ; slight- 
est remission observed. 

20th. — Intense headache ; pyrexia violent ; tempera- 
ture 109°; fetid secretions; mouth and gums tender; 
mercurial foetor perceptible. 

21st. — Describes his headache as more acute; no alter- 
ation. 

22nd. — Pyrexia ; headache ; thirst ; tongue darkly 
coated; stomach retentive; bowels open; pulse 120; 
temperature the same as yesterday. Vespere, delirious. 

23rd. — Restless, and much confused. 

24th. — Passed a bad night, tossing about the bed ; pulse 
small, 110 ; skin hot and dry. 

25th. — No improvement; pulse small, 100. 

26th. — Still delirious ; less heat ; bowels open. 

27th. — Delirium not so violent ; pulse 90, rather 
stronger; tongue clean. 

28th. — Still incoherent ; occasionally answers ques- 
tions ; pulse 80 ; eyes glassy and bloodshot ; skin alter- 
nately hot, dry, and moist ; bowels open. 

29th. — Passed a bad night: pulse 90, easily com- 
pressed ; comatose ; eyes horny ; skin alternately dry and 
moist. 

30th. — No alteration ; vespere, stertorous breathing ; 



94 



BILIOUS REMITTENT FEVER. 



eyes and countenance ghastly • moans frequently ; involun- 
tary stools ; temperature of the skin below the normal 
state ; the gas which evolves from the body has a peculiar 
smell. 

July 1st. — Perfectly insensible; coma; breathing la- 
borious ; moves his body from side to side ; pulse tremu- 
lous ; vespere, subsultus. 

2nd. — Died at 10 o'clock this morning. 

This patient had a hard struggle ; his constitution was 
vigorous and unimpaired ; but he never recovered the first 
paroxysm, which was more than twenty-four hours ; in- 
deed, the remissions were never perfect; diaphoretic me- 
dicines had no effect ; calomel was given daily in small 
doses, and we find on the fourth day that his mouth and 
gums were tender ; there are practitioners who would have 
been inclined to believe this was favourable ; I had, however, 
not the least faith in it, when the symptoms kept up as 
they did on the 21st and 22nd. On the evening of the 
22nd he was delirious ; from that moment the symptoms 
gradually became worse and worse. There was nothing 
extraordinary in the morbid appearances on dissection ; 
the liver was perfectly sound, the appearances of the 
brain would not indicate the apparent functional derange- 
ment which existed during the illness. 

June 23rd. — H. G. S , aged 30 ; delicate habit ; 

phlegmatic temperament ; eighteen months in the island ; 
rather a free liver ; attacked with severe rigours, followed 
by pyrexia a day or two ago ; did not fancy himself sick : 
attributes his complaint to cold taken after leaving an 
evening party, where he acknowledges he took too much 
wine. I did not see him until the following day, the 



BILIOUS REMITTENT FEVER. 



95 



24th, when he said his skin was burning hot; pulse 110 ; 
tongue foul ; thirst great ; skin tinged yellow ; conjunctiva 
yellowish; bowels free; temperature in the axilla 106°; 
blue pill, combined with calomel and colocynth, in a small 
dose of each, was given every fourth hour, with 3ij. aq. 
ammoniae acet. in warm barley-water. 

25th. — Pyrexia severe this morning ; tongue loaded ; 
bowels freely evacuated ; pulse 90 ; eyes and skin of a 
deep yellow ; temperature of skin (which is disagreeably 
dry) 107° ; continue the remedies, cold applications, blis- 
ter between the shoulders. 

26th. — Had a rigor this morning ; shortly after the fever 
came on very severe ; thirst great, soda water draughts. 

27th. — No alteration. Vespere, great despondency and 
depression ; pulse weak, 96 ; pyrexia was followed by a 
slight rigor. 

28th. — No rigor ; pyrexia continued ; heat of skin 108° ; 
moans and cries ; wishes for a glass of bottled porter ; 
skin and conjunctiva deeper yellow ; relished the porter. 

29th. — Before morning he says he had some sleep, but 
is now very weak and cold ; tongue loaded ; great anxiety 
as to his fate ; asked for more porter, is sure it will do him 
good. 

30th. — Countenance cadaverous ; pulse small and inter- 
mitting; tongue loaded ; bowels open. 

July 1st. — His mind appears greatly depressed ; no other 
alteration. Two p.m., comatose. Vespere, motionless. 

2nd. — Never moved during the night; towards five 
o'clock in the morning he appeared to recollect and men- 
tion familiar names. 

3rd. — A bad night ; frequent chills and pyrexia ; pulse 
98, small ; tongue loaded ; bowels free ; great thirst ; very 
restless; answers questions rationally ; skin very yellow ; 



96 



BILIOUS REMITTENT FEVER. 



the discharge from the blisters stains the bed-linen a deep 
yellow ; vespere, coma ; in articulo mortis ; died at two 
o'clock the following morning without a struggle. 

July 25th. — J. B , aged 32 ; sanguine temperament ; 

arrived in the island in March last ; has hitherto enjoyed 
good health ; given to tippling ; last night, after a free 
libation, was seized with rigor, followed by pyrexia ; he was 
worse towards the evening, but thought it would go off by 
taking a hot potion at bed-time. 

26th. — Strong fever this morning ; headache ; thirst ; 
foul tongue ; eyes red and watery; pulse 110 ; tremors of 
the muscles ; temperature of the skin 107°; head shaved 
and blistered, cathartic medicine, cold sponging. 

27th. — Bowels well acted upon ; pyrexia and oppres- 
sion at the praecordia violent ; headache unabated ; thirst 
urgent; loaded tongue; pulse 110; temperature in the 
axilla 108°; eyes glassy and red; great aversion to light . 
no symptom of vomiting. Calomel and James's powder in 
small doses ; continue affusio frigida. 

28th. — Less fever ; thirst not so great ; bowels free ; 
pulse 96 ; skin hot, rather moist ; eyes and tongue as yes- 
terday. A grain of sulph. quina with the powders every 
third hour ; effervescing draughts. 

29th. — A bad night ; in every other respect no change ; 
occasional disposition to vomit. 

30th. — Much the same as yesterday. 

31st. — Became delirious during the night : symptoms of 
great debility, approaching to collapse. Four p.m., got 
up from his bed, went to the night-chair, remained there 
a few minutes ; after returning to bed, pulsation left the 
wrists, temples, and carotids : a death-like coldness im- 
mediately pervaded the trunk and extremities ; the skin 
became patched with numerous purple spots; eyes fixed; 



BILIOUS REMITTENT FEVER. 



97 



laborious breathing ; death closed the scene in less than 
one hour from the time he got into bed — a victim to his 
own imprudence. 

The following is a similar case, and occurred three days 
after. 

John S , aged 29, an Irishman ; cachectic habit 

of body ; a hard drinker, though seldom drunk ; has 
hitherto enjoyed good health ; attacked with headache, 
nausea, and lassitude, early this morning, August 3rd, 
which he attributed to the bad quality and probable over 
quantity of rum-punch he drank yesterday evening; he 
has pains all over the body ; great thirst ; pyrexia ; mus- 
cular tremors; watery eyes; pulse 100; tongue coated, 
dirty white ; face, arms, and body, covered with lichen, 
interspersed with small vesicles. Vespere — has had 
several bilious evacuations, complains of great nausea 
and pain at the pit of the stomach ; eyes and skin slightly 
tinged yellow ; skin alternately dry and moist ; tempera- 
ture 107°; great anxiety, and terribly alarmed at his 
state. 

4th. — Bow r els free ; says all that has been done for him 
has afforded no relief ; the body and neck covered with 
lived patches. 

5th. — Pyrexia violent; eyes glaring, averse to light; 
great headache ; thirst ; pulse 120 ; vesicular eruptions 
cover the body ; temperature under the axilla 109°. Me- 
ridian — collapse ; involuntary discharges of black blood 
like fluid. Died at three o'clock ; fifty -three hours after 
the employment of remedies. 

S. C , Esq., aged 21 ; sanguine, delicate tempera- 
ment ; short figure, muscular ; a native of Jamaica ; re- 
turned to the island about four months, after fourteen years, 
absence in England and on the Continent for his educa- 



98 



BILIOUS REMITTENT FEVER. 



tion ; he was preparing himself for a barrister, and only 
visited his native parish for the purpose of examining into 
the affairs of his estate, and merely awaited the arrival of 
his brother, who was hourly expected, ere he should take 
his departure. His habits have been, since in the island, 
extremely temperate, but he has occasionally exposed 
himself imprudently to the sun, at the hottest time of the 
day, in pursuit of field-sports. Hitherto he had suffered 
no apparent ill effects, nor did he feel fatigue or any 
inconvenience from the climate, until after a very long 
journey on horseback on Friday evening, when he was 
seized with rigors and headache, but not severe. By 
the advice of the consignee of the ship in which he 
anxiously expected his brother, he took some hot tea and 
a warm bath, and retired to bed early. On the following- 
day he had a return of the rigor and fever, of short dura- 
tion ; in the afternoon his brother arrived, and he was in 
good spirits, but could not eat dinner ; he complained of 
headache in the evening, and went to bed. 

About six o'clock in the morning of 27th June, I was 
sent for, and saw him shortly after. He stated that he 
had been very restless all night ; he had strong pyrexia, 
headache, pains in the loins and legs, tongue very foul, 
moist, and clammy ; he felt annoyed at a frequent desire 
to spit which he could not control ; skin was hot, moist, 
and clammy, at this hour ; pulse weak, 100 ; bowels con- 
fined for two days; not much thirst; said he could not 
take pills ; he was directed to take five grains each calomel 
and James's powder every third hour, after the bowels 
had been opened by infusion of senna with sulphate of 
magnesia. At one p. m. his bowels had been relieved three 
times, and he had taken two of the powders with a saline 
draught. Skin hot and moist ; thirst moderate ; pulse 



BILIOUS REMITTENT FEVER. 



99 



100. Six p. M. — pyrexia violent ; pulse 110; tongue hard 
and dry ; thirst excessive ; skin parched, and extremely 
disagreeable to the touch ; temperature 109°; slight aber- 
ration of mind, with occasional muttering, as if talking to 
himself. Imponat. vesicatorem inter scapulas. Continue 
the powders and draughts ; cold sponging without inter- 
mission. Ten p. m. — pyrexia unabated ; no alteration. 

28th. — Six a. m. Before three o'clock he had torn off 
the blister, and was outrageous at its application. Slight 
remission ; skin soft, hot, and clammy ; pulse 100, weak 
and wiry ; eyes red and watery ; tremors of the muscles ; 
thirst urgent ; acute pain in the left hypochondrium ; 
strangury. Warm fomentation to the painful part ; after- 
wards apply emplastrum vesicator. ; camphor mixture with 
aq. ammonias acet. aa., half an ounce after each powder. 
Six p.m. — Copious alvine discharges, thin, foetid, and 
ink-like ; pyrexia violent ; skin hot and dry ; temperature 
at various parts of the body 109°, under the axilla 109J 0 ; 
thirst excessive; soda water ad libitum. Continue the 
cold applications ; indeed he is very zealous to have this 
attended to. Ten p.m. — pulse at this hour was tremulous, 
weak, and 1*20 ; appears rational, and free from pain. 

29th. — Passed a bad night: the attendants stated that he 
was watchful and irritable ; pyrexia unabated ; pulse ir- 
regular, from 130 to 140; tongue dry, produced with 
difficulty; great prostration of strength; bowels open, 
dejections less fetid, but quite black; enemata. Continue 
the medicines, &c. Meridian — no alteration. Asks for 
cold water , gave him some with hock, which he relished. 
Whilst remaining with him for nearly one hour, H.M. ship 
Isis in the harbour of Port Antonio, during the time, was 
exercising her guns by firing at a mark ; notwithstanding 
the thundering reports of her thirty-two pounders, he ap- 

h 2 



100 



BILIOUS REMITTENT FEVER. 



peared unconscious of the noise, although at no great dis- 
tance from the ship. This, in concert with the other sym- 
toms, I regarded as very alarming : he was nearly deaf. 
Seven p. m. — Symptoms of coma ; is quiet ; has vomited 
green mucous bile ; pyrexia less ; pulse intermits ; bowels 
slow ; enema purgans. Midnight — no alteration. 

30th. — Says he slept about four hours ; remission ; hock 
and water, with three grains, sulph. quina every second 
hour; bowels open, dark, tar-like stools; gums tender; 
mercurial fetor perceptible. Ten a. m. — Keeps the hock 
and beef-tea. One o'clock p. m. — Three copious alvine 
evacuations ; pyrexia returned at twelve ; complains of 
nordinate thirst and great heat; temperature averages 110 ; 
skin and eyes slightly tinged yellow ; talks remarkably 
quick, but sensibly. Seven p. M. — Very restless ; eyes roll 
with rapidity ; a remission of the preternatural tempera- 
ture, which is now 104° ; no other alteration. 

At midnight I received a report, briefly stating that he 
was again attacked with fever as hot as ever, with slight 
delirium and restlessness. I did not see him at this hour, 
but merely directed the febrifuge remedies, and the cold 
applications to be continued. 

I was sent for about two hours after this message 
had been delivered ; every part of his body at this hour, 
half-past two A. M., was bathed in clammy perspiration ; 
the body is studded with purple patches in detached 
and different sizes ; talks with a quickness and vivacity 
unaccountable, relating scenes of his boyhood in a very 
lucid and interesting style. If asked how he felt, his 
answer was remarkably hurried, but always, " Oh, I 
am very well." Pulse very rapid, and small ; bowels 
torpid ; enemata repeated ; hock and soda-water. Al- 
though in this deplorable condition, he replies to every 



BILIOUS REMITTENT FEVER. 



J01 



question rationally, produces his tongue easily, and re- 
tains everything which is given to him. Three o'clock. — 
Very weak ; nearly fainted when on the night-chair. Six 
p. M. — Cannot be worse ; pulse fluttering ; tongue tremu- 
lous ; constantly muttering ; skin cold and clammy ; black 
sordes covering the teeth and gums. Died, without a 
struggle, at eight o'clock. 

Few cases, probably none, better illustrate the capri- 
cious symptoms of this disease than the one above which I 
have just extracted from my records. The disease had 
made some advance, and had got a firm hold of his sys- 
tem, two days before any remedy was applied ; the pre- 
disposing causes of fatigue, exposure to the sun, and 
malaria whilst shooting, added to which, his anxiety 
about his brother,- — all tended to keep the enemy within 
the camp. The early symptoms were exceedingly alarm- 
ing ; the temperature of the system was never reduced 
until seven o'clock p. m. of the 30th ; then the remission 
was but of short duration, previous to which there was 
one fatal prognostic present, that of deafness. 

A. J. A . Thin habit; bilious choleric tempera- 
ment ; aged 25 ; in the island four years ; has suffered 
from occasional trifling indispositions. Seized last night? 
28th August, with rigors, nausea, and headache and fever, 
which prevented him sleeping one moment. 

29th — At eight o'clock a. m. I found him suffering from 
intense headache, pain down the spine and legs ; pyrexia ; 
pulse 100, weak and vibratory; eyes red and watery; 
tongue clean ; bowels constipated ; pil. cathartic, gr. v. duo 
secun dis horis; emplast. vesical.; applicetur inter scapulas. 



102 



BILIOUS REMITTENT FEVER. 



Six p. m. — Medicine operated well, headache somewhat 
relieved ; pulse 100, more expanded and regular. 

30th. — Apyrexia at six a. m., has slept since ; blister 
rose well ; headache less ; was very thirsty during the 
night ; stomach retentive ; hock and water, with quinine 
every second hour; skin warm and moist, not preter- 
naturally hot, pulse 96. Vespere— pyrexia returned at 
two p. m., with headache, thirst, and restlessness ; tongue 
brown; pulse 105; skin hot and dry; temperature 106°; 
several watery fetid dejections since morning; eyes 
water ; looks indicative of great depression and melan- 
choly, Calomel, camphor, and James's powder, two 
grains each every second hour, with saline draughts ; soda- 
water occasionally : cold sponging. 

31st. — Pyrexia unabated; no alteration in the symp- 
toms since last visit ; had a restless night. Vespere — no 
change. 

September 1st. — Apyrexia, free from headache; thirst 
and pains ; tongue foul but moist ; bowels freely open ; 
secretions, dark green, fluid, and very fetid ; skin clammy ; 
pulse 90. Repeat the wine and quinine as before ; asked for 
soda-water in effervesence — let him have a moderate draught 
occasionally. Vespere— took four draughts; rejected the 
fifth, and complained of thirst ; pain in the bowels, with 
great prostration of strength ; pulse 100, w r eak and tremu- 
lous ; skiu tinged yellow ; discontinued the purgative 
medicines ; substitute fomentation and enemata, with oily 
friction. 

2nd. — Apyrexia : bowels open ; pulse 100, weak and 
wiry; eyes red, and watery; conjunctiva yellow; skin 
warm, moist, and clammy; countenance void of expression; 
continue the wine and quinine. Vepere— still free from 
fever. Continue remedies as at last visit. 



BILIOUS REMITTENT FEVER. 



103 



3rd. — Had a few hours sleep the first part of the night ; 
then he became restless, and disturbed with fanciful 
dreams ; had rigors and flushes of heat ; complained 
particularly of a peculiar sensation in the brain, and 
described the want of feeling in his neck, " as if his head 
had no connexion with his body." Pulse 100, weak ; 
tongue cleaner ; temperature of the skin not above 100°. 
Repeat the powders and draughts. Vespere — apyrexia ; 
is easy and more cheerful. Repeat the wine and quinine. 

4th. — Had a good night. Gradual convalescence. 

P. C , 22nd regiment, an Irishman, one year in 

the service; sanguine temperament and good constitution; 
admitted into the hospital yesterday afternoon, 28th 
October. 

29th. — Complains of sickness at the stomach, headache, 
pain in the back and loins, and prostration of strength. 
His pulse full and frequent, 110 ; skin hot ; tongue 
covered with white fur. Vespere — has extreme heat, 109°, 
and dry skin ; great thirst ; pains have left him ; bowels 
moved freely ; evacuations dark, containing much vitiated 
bile. Pills of calomel and ext. colocynth ; cold appli- 
cations. 

30th. — Was restless during the night; skin hot and 
dry, but the cold ablution is found very useful ; tongue 
continues white ; pulse 100, firm and regular ; bowels 
open ; bilious dejections ; towards evening the vomiting 
returned, and has since rejected everything nearly in the 
state in which it was swallowed. 

31st. — Was very uneasy during the night; showed a 
tendency to delirium ; great thirst ; incessant vomiting ; 
tore off the blister from the pit of his stomach, and would 
not surfer it to be replaced ; bowels were open freely 
during the night; pulse frequent ; debility rather increased. 



104 



BILIOUS REMITTENT FEVER. 



Vespere — no alteration ; at nine p. m., gave a camphor 
draught, with forty drops of solution of morphia. 

November 1st. — Head less affected ; skin partially 
moist ; extreme debility ; the edges of the tongue are 
brown, centre white ; teeth and lips partially black ; pulse 
120, small. Wine, camphor, soda-water. Evening — 
some tendency to coma ; eyes suffused, and the neck is 
yellowish ; less irritability of stomach ; taken his medi- 
cines and diluted wine well ; bowels not open since 
morning. Repeat the cathartic pills ; enema. 

2nd. — The yellow tinge is all over the body ; the tem- 
perature of the body not above 100°; tongue as yesterday; 
skin moist; pulse 120; thirst moderate. Vespere — 
bowels moved twice : dejections dark and fetid ; inclined 
to coma ; shaved the scalp, and applied a blister. Con- 
tinue the remedies. 

3rd. — Groaned incessantly during the night ; did not 
refer his uneasiness to any particular part ; debility and 
comatose tendency increased ; no vomiting since five 
yesterday evening ; eyes dull and yellow ; much anxiety ; 
pulse 120 ; tongue and lips coated. Vespere — debility 
increased ; pulse 126, small and oppressed ; takes his 
wine and medicine w T ell, and retains it. — Seven o'clock, 
quiet and unconscious; died at ten o'clock. 

October 10th. — George A , aged 34, deeply 

marked with small-pox, of intemperate habits ; broken 
constitution ; did not report himself sick, but was sent to 
the hospital by one of the sergeants who saw him vomiting 
in the rear of the barracks. On being questioned, he said 
that he had been unwell that morning; but, attributing 
his illness to his having drunk too much rum the day 
before, he did not report himself; says that, at present, he 
only experiences irritability of stomach, with some weak- 



BfLIOUS REMITTENT FEVER. 



105 



ness in his limbs ; no headache, nor pain of back ; skin 
cool ; pulse rather hurried ; tongue moist, foul at the base; 
bowels open. Vespere — when visited in the afternoon, 
was found asleep, bathed in a profuse perspiration ; pulse 
full ; said that he felt himself very well. 

11th. — Left the hospital after breakfast, and retired to 
his barrack-room, where it is said he remained quiet, 
although it was at first apprehended that he had gone to 
the canteen. He returned to the hospital at four o'clock, 
labouring under considerable dyspnoea ; hot, dry skin, 
with hurried circulation ; tongue dry and red ; pulse 120 ; 
bled to eighteen ounces. Eight o'clock—dyspnoea re- 
lieved ; vomited, since four o'clock, greenish fluid, since 
which he has remained tranquil and inclined to sleep ; 
skin warm and moist. Pills of calomel, each four grains, 
every second hour, with saline draughts. 

12th. — Is reported by the orderly sergeant to have lain 
quiet until six o'clock, when he attempted to get out of 
bed : shortly after he was seized with low delirium, con- 
stantly muttering, and tossing about in his bed ; he con- 
tinued in this state two hours, when he relapsed into a 
state of complete coma, in which state I found him at 
seven o'clock ; breathing laborious ; extremities cold ; 
face and chest covered with livid spots ; the skin quite 
yellow. Twelve o'clock — dyspnoea increased ; appears 
sinking fast ; teeth covered with sordes ; the body a deep 
orange colour. One o'clock — moribund. Two o'clock — 
died. 

October 19th. — John N , aged 39, sanguine tem- 
perament ; eight years in the service, nearly two of which 
he had been in the island ; has the character of a sober 
and diligent soldier. Had rigors early this morning, fol- 
lowed by the usual symptoms, headache, nausea, and 



106 



BILIOUS REMITTENT FEVER. 



frequent vomiting of dark bilious matter ; skin intensely 
hot and dry ; temperature 108J 0 ; pulse 90, very tense and 
full ; tongue dry ; much thirst, with distension and pain 
of abdomen ; bowels not free. Tepid bath immediately ; 
bled to twenty-four ounces, when he fainted ; a blister to 
the back of the neck and occiput, another to the epigas- 
trium. Enema ; took ten grains calomel with twenty 
grains of jalap. Vespere — pyrexia continues intense with 
a tendency to delirium ; temperature of the body 109° 
under the axilla ; skin feels parched ; pulse 90, rather 
full ; complains of pains in the orbits ; has had frequent 
dark evacuations during the day. Cold applications ; 
repeated the powder. 

20th. — Very delirious all night, had to be held in his 
bed ; is now, eight o'clock, more quiet, but not collected. 
Says he is quite well, and wishes for his clothes ; bowels 
free ; very dark evacuations ; tongue dry, with incessant 
thirst ; pulse 85 ; respiration free and natural ; eye dull 
and inexpressive ; conjunctiva yellow ; skin moist, hot, 
and clammy. Blisters to the temples ; five grains calomel, 
with two grains of James's powder, every second hour ; 
saline draughts and soda-water occasionally. Vespere— 
delirium continues, considerable excitement occasionally ; 
pulse 90, firm ; thirst great ; skin hot and dry. Warm 
bath ; bled to twenty -four ounces ; bowels open. 

21st. — Delirium less violent; no sleep; skin cool and 
clammy ; yellow at the neck and chest ; respiration calm 
and free ; tongue dry, black towards the root ; eye dull 
and vacant, pupils dilated ; several dark and offensive 
stools during the night ; blisters discharge freely. Con- 
tinue the powders, enema occasionally. Vespere — is 
apparently much in the same state as in the morning ; 
is delirious, but quiet ; heat of surface natural, moist ; 



BILIOUS REMITTENT FEVER. 



107 



tongue and lips very dark red. Continue the powders 
and draughts. 

22nd. — Had a bad night, required to be held in his 
bed ; vomited a large quantity of black coffee-ground 
mixture ; tongue and lips nearly black ; pulse 85, weak ; 
yellow all over the body; passes similar looking fluid 
downwards, as he is now vomiting freely; when roused to 
take his medicine, he says he is quite well, and wishes to 
get up. Vespere — very low, sinking rapidly ; died at 
midnight. 

SECTIO CADAVERIS. 

Membranes of the brain much inflamed ; the veins and 
different sinuses were completely gorged with dark 
coloured fluid, unlike blood ; effusion into the ventricles 
not so great as might have been expected. 

The viscera of the thorax were healthy ; liver somewhat 
enlarged, but not changed in structure at any part ; gall- 
bladder full, the bile very dark green. Stomach, villous 
coat studded with minute petechias towards the pyloric 
orifice ; appeared more inflamed in patches ; contained 
about a pint and a half of the dark flaky fluid, similar to 
what he had vomited ; kidneys larger than usual ; bladder 
empty. 

John C , aged 20, admitted this day, 22nd 

December ; is a native of Ireland ; has been three years in 
the island ; full plethoric temperament ; great febrile 
excitement ; headache, pain in the back and loins, nausea, 
and frequent ineffectual efforts to vomit; pulse 100; heat 
of surface great ; much throbbing of the carotids and 
temporal arteries ; flushed face ; eyes red and watery ; 
tongue loaded; bowels slow; respiration hurried; much 



108 



BILIOUS REMITTENT FEVER. 



anxiety and considerable prostration of strength. Bled to 
thirty-six ounces ; temperature of the blood ascertained 
as it fell rapidly into the basin, to be 107°; enema imme- 
diately after the warm bath ; a calomel pill every second 
hour; saline draughts. Vespere — bowels open; has 
vomited frequently ; in the efforts to vomit, the arm 
burst out bleeding, and by the sergeant's computation 
he may have lost about ten ounces of blood ; still com- 
plains of the headache. Solution of argentum nitrat., 
ten drops every half hour, until vomiting is relieved. 

23rd. — Says he was much easier after the bleeding, and 
he had some sleep ; the acute symptoms have for the 
present abated ; pulse 90, soft ; tongue still loaded ; head- 
ache much diminished ; skin hot and dry ; bowels open ; 
complains of slight nausea ; pain on pressure at the epi- 
gastrium. Cold applications to the head and body; a 
blister to the pit of the stomach. 

24th. — Had no particular complaint at last night's visit ; 
an accession of fever ushered in by rigors ; came on in the 
night, and continues ; is thirsty ; tongue less loaded ; 
bowels acted twice. Meridie — pulse 86, of moderate 
strength ; apyrexia, and says he is perfectly easy- 
Directed three grains sulphate quina every third hour. 
Vespere — states himself to be quite well ; but the skin is 
deficient in natural heat, it is dry and torpid ; tongue very 
dry, and furred ; several dark, fetid evacuations ; pulse 90 ; 
headache returns occasionally ; abdomen distended, no 
pain on pressure. 

25th. — Had an uneasy night, owing to going to the 
night-chair so often ; surface more natural, slightly moist ; 
pulse 86 ; tongue cleaning at the edges, dark fur in the 
middle and root ; is thirsty, but free from pain. Small 
doses of calomel, with camphor and James's powder, every 



BILIOUS REMITTENT FEVER. 



109 



second hour. Vespere — has had slight febrile excitement, 
and it continues ; it came on about one hour ago with 
chilliness ; skin dry ; temperature 107°, and horridly dis- 
agreeable to the touch ; complains of return of pain at 
the epigastrium, and giddiness when he sits up ; pulse 90, 
of good strength. Opened the temporal artery, drew off 
sixteen ounces of blood ; applied blisters behind each ear, 
and to the temples ; continue the powders ; soda-water. 

26th. — No sleep last night; bowels free; symptoms 
less severe ; pulse 80, rather diminished in strength ; eyes 
languid ; conjunctiva yellow ; mouth appears slightly 
affected with mercury ; camphor mixture with aqua 
ammonia acetate. Meridie — had several ineffectual at- 
tempts to vomit ; evacuations dark and fetid. Continue 
the powders and mixture. Vespere — is much in the same 
state ; skin is moist ; pulse 80. 

27th. — Slept at intervals during the night. Urine very 
high coloured ; pulse 86 ; skin hot and dry, very yellow : 
dark fetid stool. Meridie — heat of skin below the normal 
state ; countenance expressive of great anxiety ; tendency 
to delirium ; pain in the bladder. Vespere — the fomenta- 
tions have afforded ease; secretion of urine increased; 
skin moist, hot, and clammy ; in touching it, a peculiar 
sensation remains at the ends of one's fingers. I have 
never been able to describe this feeling to my own satis- 
faction. Continually talking ; is very restless ; bowels free, 
and quite easy. 

28th. — Violent delirium ; cadaverous smell from the 
body ; deglutition impeded. Vespere — no alteration. 

29th. — Died early this morning. 

SECTIO CADAVERIS. 

Great stagnation of blood in the superficial veins of the 



110 



BILIOUS REMITTENT FEVER. 



brain, with serous effusion into the ventricles ; substance 
of the brain firm ; the plexus choroides appeared to be 
converted into substance like clotted blood. Contents of 
the thorax healthy ; villous coat of the stomach inflamed 
near the cardiac orifice ; liver very much congested ; 
spleen large ; kidneys healthy ; bladder normal, but 
empty. 

August 16th. — James Gray, aged 26 ; sanguineous tem- 
perament ; four years in the service ; admitted with active 
febrile symptoms ; rapid arterial action, nausea, anorexia, 
headache ; skin hot and constricted ; temperature 105° ; 
bowels slow. Directed pediluvium, cathartic powders, 
calomel and jalap, saline draughts. 

17th. — Bowels freely acted upon; pain affects the loins 
and extremities; pyrexia; tongue loaded; pulse 110; 
eyes dull ; sighs frequently ; urine highly coloured, stains 
the linen ; temperature 105° ; complains of great uneasi- 
ness and anxiety ; had no sleep, in consequence of the 
extreme heat of the fever, which he states was increased 
by the confinement of the ward. It was a rainy night, 
and, in consequence, all the jealousies in the veranda 
facing the north and east were closed. A blister between 
the shoulders ; continue the saline draughts ; pills of ca- 
lomel and colocynth every second hour ; cold sponging, 
without intermission, as long as the paroxysm of fever 
lasted. Vespere — vomited and purged frequently ; tongue 
the same ; pyrexia urgent ; complains of pain in the eye- 
balls and temples ; thirst less urgent ; no other alteration. 
Continue the saline draughts ; omit the pills ; cold ab- 
lution. 

18th. — Passed a bad night ; had a little sleep towards 
morning, but was often disturbed by the noise in the 



BILIOUS REMITTENT FEVER. 



Ill 



barracks ; skin is softer, and the pulse 100 ; tongue dark 
and tremulous ; eyes dull ; conjunctiva suffused, a bright 
yellow; the neck and breast slightly tinged; temperature 
under the axilla 105° ; has not vomited during the night, 
but stated that he felt sick at the stomach every time 
he went to the night-chair, but as soon as he returned 
into bed it wore off. Three grains calomel with two grains 
camphor, and a saline draught, every second hour. Ves- 
pere — between two and three p. m. the sergeant reported 
that he had rigors, and called for additional covering. 
It is now six p. m., and I find him bathed in profuse 
perspiration; headache not so violent ; pulse 100, small; 
tongue still dirty brown, but moist ; eyes more animated, 
but the conjunctiva is very yellow ; the whole body par- 
takes of the same hue ; temperature under the axilla 105° ; 
the skin is very hot, notwithstanding the perspiration, 
but, generally speaking, he is more tranquil ; his voice is 
better, and there is less anxiety; bowels free; dejections 
green bilious fluid. Continue the powders and draughts, 
warm barley-water ad libitum : this he called for, and 
prefers to any other fluid. 

19th. — Free from fever; had about three hours' very 
sound sleep ; pulse 90, firm and regular, but not full ; 
tongue the same ; free from headache and pain, although 
he says the balls of his eyes are very hot and disagree- 
able; temperature this morning under the axilla 104°; the 
skin is moist and soft ; bowels free ; dejections very 
bilious. Continue the remedies as yesterday. Vespere — 
no alteration ; lies quiet, but has not slept. Continue. 

20th. — Eight a. m., pyrexia urgent ; ushered in by a 
constant disposition to yawn and stretch, then followed 
rigor which shook every part of the body ; his teeth, he 
says, chattered for more than an hour ; he was obliged to 



L12 



BILIOUS REMITTENT FEVER. 



have additional covering until seven o'clock, when the 
fever came on burning hot, and his thirst was, and is, 
intolerable; pulse 110, small and weak; tongue red at 
the sides, still dark brown in the centre; great pulsation 
at the carotids ; headache returned, and pain in the eye- 
balls; vomited only once, which was just before the rigor 
assailed him ; says he feels so weak that he can with 
difficulty only sit up ; temperature of skin 104°, under 
the axilla 105°; the colour of the body and extremities 
resembles that of a reddish yellow orange. Resume the 
cold applications ; continue the powders of calomel and 
camphor, the saline draught, and the barley-water. Ves- 
pere — pyrexia continues ; very weak, restless, and much 
alarmed ; pulse 110 ; tongue dry ; thirst urgent ; asked for 
cold brandy and water ; respiration hurried ; complains of 
tightness and pressure at the praecordia. Directed half a 
grain acetate of morphia in one ounce aqua ammonia 
acetate, at eight o'clock. Discontinue the powders and 
draught ; allowed small quantities of weak brandy to be 
given during the night. 

31st. — From the hour of eleven he slept well until day- 
light, and when he awoke he was in a profuse perspiration 
and quite easy. At eight o'clock this morning he appears 
free from ailment: pulse 90; tongue moist, ash colour, 
and covered with tenacious fur ; skin and eyes very 
yellow. Two grains sulph. quina, pil. hydrarg. and 
extract rhaei, every second hour. Vespere — apyrexia : in 
all respects better ; bowels open. Repeat the draught 
same as last night. 

22nd. — Apyrexia; had a quiet night: slept the most 
part of it, off and on ; is more cheerful, and sits up well ; 
gradual convalescence. 

17th November. — Charles Townley, aged 25, an 



BILIOUS REMITTENT FEVER. 



113 



Irishman, pale complexion ; sickly, weakly constitution. 
Admitted this morning into hospital, with headache, 
thirst, restlessness, pains in the left side, back and limbs ; 
extreme irritability of stomach ; face sallow ; extremities 
below, considerably below, the normal temperature ; body 
hot and dry ; pulse very variable ; bowels constipated. 
Enema immediately ; as soon as a warm bath is prepared, 
immerse the whole body up to the neck for ten minutes. 
Pil e colocynth et calomel ; number, two every second 
hour. Apply a blister to the serobiculus cordis. 

18th. — No change for the better ; bowels freely open ; 
extremities warm ; pulse firm ; temperature under the axilla 
105°; sickness at the stomach less : has vomited altogether 
three times during the night ; pain in the left side ; 
severe griping and tenesmus. Enemata, two ounces ol. 
ricini immediately : a blister to the side affected ; tongue 
white. Vespere — pyrexia continues: complains of the 
blisters; strangury very painful; tenesmus not so bad. 
The castor oil operated powerfully : anodyne draught at 
eight o'clock. 

L9tli. — Had slight remissions last night: was in a per- 
spiration occasionally, for a short time ; tenesmus has left 
him ; had voided a small quantity of urine ; stomach 
quiet; tongue foul; pulse 100, very feeble; temperature 
of the body nearly natural. Vespere — no alteration ; 
apyrexia. Quinine in solution ; arrow root and wine. 

20th . — No fever: improving, but extremely weak. 

29th. — With the same treatment as adopted at first, he 
continued, after frequent changes, to mend in his general 
health, but slowly, having occasional relapses, with a 
paroxysm of fever every second day. 

December 6th. — Convalescent. 

C. B , merchant in the lower town : sanguine 

i 



114 



BILIOUS REMITTENT FEVER. 



temperament ; plethoric habit of body. Sent for advice 
early this morning, in consequence of severe headache 
and giddiness ; general soreness ; pain in the loins : the 
least pressure on the stomach caused pain; surface of 
the body covered with clammy perspiration; bowels 
irregular ; tongue furred and dry ; pulse quick, soft, and 
easily compressed. 

Hydrarg. submurias, gr. decern. Extracti colocynth. 
comp. gr. sex. Fiant pil. tres, quatuor horis interpositis, 
haustus salin. hora somni ; descend, in balneum tepidum. 

14th. — Passed a very restless night ; face very much 
flushed ; surface of the body hot and dry ; temperature 
106°; some irritability of the stomach, and pain on pressure; 
severe pain in the region of the occiput ; tongue brown 
and dry in the centre, red at the edges ; pulse quick, small, 
and compressible ; bowels freely opened. 

Descend, in balneum tepidum. Capiat solut. argent, 
nitrati minim, decern, omni trihorio, habeat enema domest. 
Appl. empl. lyttae scrobi cuius cordis. 

Vespere — pyrexia continues : has less pain ; complains 
of fulness at the lower part of the bowels, and strangury. 
Fiat injiciat enema domest. Continuentur remedia ut 
mane. 

15th. — Spent a very restless night ; irritability of sto- 
mach not so urgent ; pain in the occiput increased ; 
abdomen somewhat swollen ; surface of the body, and 
more particularly the face, of a purple hue ; dysuria very 
painful ; pulse quick and small ; tongue dry and parched. 
Repetatur enema domest. ; idem, balneum tepidum. 

Be. Submur. hydrarg. Pulv. camphorse. Bismuth 
oxidi aa gr. decern, dividendum in chartulas quatuor ; 
capiat unam secundis horis. 

Vespere — pyrexia: retained all his powders; dysuria 



BILIOUS REMITTENT FEVER. 



115 



not so distressing ; no alteration in the appearance of the 
body; the conjunctiva is yellowish; pulse 110, very 
small, with difficulty felt ; his wrist is fat ; pain still con- 
tinues severe at the occiput. Repetatur pulv. ut ante ; 
habeat haustum effervescen. pro re nata. 

16th. — Expresses himself greatly relieved this morning ; 
tumidity of the abdomen rather increased, accompanied 
with difficulty of breathing ; pulse quick, soft, but rather 
fuller ; tongue parched ; skin same colour, hot and dry ; 
irritability of stomach returned. Repetatur balneum tepi- 
dum. Cont. medicamenta ut here. 

Vespere — the difficulty of breathing still continues ; 
pulse very small and frequent ; tongue still dry, and red 
at the sides ; eyes very languid ; countenance denoting 
great dejection, but resignation; bowels freely open.; 
stomach easy, but feels full and uncomfortable. 

Acet. morphise grana una. Aq. ammonia acet. Aq. 
rosar. aa unciam simessi. Aq. destillat. unciam unam fiat. 
Haustum capiat hora somni. 

17th. — Much in the same state as yesterday, with the 
exception of having passed an easy and quiet night; 
bowels freely opened ; dark fluid bilious evacuations, with 
a great deal of mucus ; feels a scalding at the rectum. 
Rep. pulv. ut prescript, die 15th. Asked again for the 
warm bath. 

Vespere — no alteration. Repetatur haustus anodynus 
ut here vespere. 

18th. — After he came out of the bath last night, he took 
the draught and perspired freely; tumefaction and pain 
of the abdomen subsided ; skin more natural in its ap- 
pearance and its temperature ; pulse 100, soft and small ; 
face and neck florid ; tongue moist, but foul. 

R. Sulph. quinse gr. viii., solv. in acid sulph. dilutum 

I 2 



116 



BILIOUS REMITTENT FEVER. 



minim decern, aq. rosar. uncias tres. Infus. radix glychar- 
risma uncias quinque ; fiat mistura ; capiat cochleariae 
majora tres secunda quaque hora. 

19th. — Apyrexia ; a copious perspiration pervades every 
part of the body. Continuentur sulph. ut ante, &c. 

20th. — Tumidity of abdomen quite gone ; perspiration 
free ; complains of a weight at the stomach, owing, as he 
states, to the nurse forcing him to take too much sago 
during the night ; feels a great desire to vomit. I left 
him with strict injunctions to take nothing for the next 
four hours. Two p. m. — is easier in all respects, except 
the inclination to vomit. 

Repetatur haustus, cum solutione argentui nitrati omni 
bihorio. 

Vespere — says that he always feels great relief after 
taking the nitrate of silver. Great prostration of strength ; 
bowels freely open; no return of fever. 

21st. — Slept badly : disturbed by dreams ; but in every 
other respect he is better ; the face is more natural, and 
his general aspect is favourable. Continue the quinine. 
Allow hock and water occasionally. 

22nd. — Improving ; went on board ship in the harbour. 

November 10th. — H. P , a native of Scotland, 

has been three years in the island, and always enjoyed 
good health until now : states that three days ago he was 
seized with a shivering, succeeded by headache, for which 
he went to bed, and next day took a dose of Epsom salts : 
the following day he was very well. He was induced to 
send for a doctor this morning, in consequence of a more 
violent return of the rigors. When T saw him, he was in 
the hot stage of the paroxysm : pulse frequent, full 
and strong ; face very much flushed ; eyes suffused ; hur- 
ried respiration ; great thirst ; skin dry and hot ; tongue 



BILIOUS REMITTENT FEVER. 



117 



white and loaded ; bowels constipated. Ascribes his 
complaint to a severe wetting in a heavy shower of rain 
on his way to town from the muster of the militia regi- 
ment, and having kept his wet clothes on all the day. 

Capiat pil. hydrarg. cum ext. colocynth. gr. viii. tertia 
quaque hora, cum haustu effervescen. 

Vespere — headache continues severe ; bowels opened by 
the pills ; face very much flushed ; great arterial action. 

Stat, flat vensesectio ad uncias xxxvi. postea balneum 
tepidum. 

11th. — Passed a very restless night ; still hot and 
feverish, with an aggravation of all the symptoms. Com- 
plains much of his head this morning ; abdomen dis- 
tended, although he has been freely purged. Repetatur 
balneum tepidum. 

R. Submur. hydrarg. ^j. Pulv. Jacobiae. Pulv. cam- 
phorse aa gr. x. : divid. in partes asquales quatuor ; capiat 
unam omni hora. 

Vespere — has been irritable and restless; hot and feverish 
all day ; headache intense ; cannot bear the light ; pulse 
100, strong and full. Repet. vensesectio ad uncias xxiv. 

R. Aq. ammon. acet. Aq. rosar. aa, §i. Mistura 
camphorae 3iv : fiat mistura ; capiat cochleariae majora tres 
secundis horis. 

12th. — Is much better this morning : slept occasionally 
during the night ; headache gone ; heat of surface nearly 
natural : pulse 80. 

13th. — Passed a very good night : states himself to be 
much better to-day. Heat of surface natural; bowels 
open : tongue cleaning. 

14th. — Still doing well : has no complaint except 
debility. 

15th. — Had rigor this morning for two hours, and 



118 



BILIOUS REMITTENT FEVER. 



vomited a great quantity of greenish bilious fluid ; skin at 
present intensely hot ; bowels open. 

Repet. balneum tepidum. Habeat solut. argent, nitrat. 
minim, decern, omni bihoris. 

Vespere — free from fever, and is easy. 

Solutio quina secundis horis, habeat haustum anodynum 
hora somni. 

16th. — No return of fever : doing well. 

17th. — No paroxysm to-day. 

18th. — Free from complaint: discontinued my visits. 

Captain P , a native of New Brunswick, a short, 

dark, sturdy, and very active seaman, sanguine tempera- 
ment. Has traded for thirteen years to the different West 
India Islands, and for the most part has had good health, 
occasionally complained, but never kept his bed. The 
night of the 13th he had undergone considerable exertion 
in a boat ; shortly after getting on board his vessel, at 
midnight, he was seized with headache, rigors, thirst, and 
giddiness : before daylight all these symptoms left him. 

14th. — About nine o'clock the rigor and headache 
returned; he took immediately four antibilious pills 
from the ship's medicine chest; at two o'clock he also 
took a dose of calomel and jalap. At night he got worse, 
and was much alarmed at the pains in his back ; oppres- 
sion, difficulty of breathing, and thirst. He drank plenti- 
fully of warm tea during the night. 

15th.— I was sent for at eight o'clock this morning : 
pyrexia was violent ; headache, thirst, and general pains ; 
no part of the body was free from pain ; tongue dark 
brown; pulse 110, small, and easily compressed; the 
body very hot, but moist ; temperature 107°; bowels not 
affected by the medicine which he took. Had him placed 



BILIOUS REMITTENT FEVER. 119 



in a warm bath immediately after a domestic enema 
had acted. 

R. Submur. hydrarg. gr. xv. Pulv. Jacobise gr. x. 
Pulv. jalapae ^ij. divid. in part. aeq. iii. : capiat unam 
secunda quaqtie hora. Haustus effervescens alternis horis. 

Vespere — pyrexia unabated ; no action on the bowels. 
Bath repeated ; enema ; continue the medicine. 

16th. — Pyrexia, pains, thirst, and oppression, same as 
yesterday ; said he was " badly off for a supply of 
breath he had not the least pain in either side ; the 
right hypochondrium was hard and swollen ; the liver ap- 
peared in a state of, as the French say, engorgement. He 
could not bear the least pressure over the region of it. 
From the noise and confusion, and want of attendance, on 
board his ship, I caused him to be conveyed to a cool 
and comfortable lodging on shore, in the lower town of 
Port Antonio, in the evening. The remedies were con- 
tinued, and the bath repeated at eight o'clock r. m. 

17th. — Pyrexia violent; tongue loaded; pulse 110, 
small and wiry ; eyes watery and tinged yellow ; great 
restlessness and anxiety ; talks rapidly, asking innu- 
merable questions about his illness ; says he is too ill to 
recover. The bowels have been freely moved; dejections 
copious, and as black as ink ; pain over the region of the 
liver continues. Continue the powders, and apply a 
blister over the region of the liver. Vespere— pyrexia not 
so violent ; the whole of the body is yellow, hot, and 
moist; temperature immediately after coming out of the 
bath, 107°. 

R. Mistura camphor 33, 3vj. Aq. ammoniae acet. Jj. 
Aq. rosar. S ss. Acet. morphias gr. i. : ft. mistura ; capiat 
cochleariae majora tres secundis horis. 



120 



BILIOUS REMITTENT FEVER. 



18th. — Apyrexia at four o'clock ; and from that hour 
has been bathed in perspiration ; bowels moved four times 
during the night : dejection as black as ink ; tongue still 
loaded; pulse 100; temperature 104°; skin very yellow; 
he is constantly looking at and remarking about the colour 
of his arms. Meridie — pyrexia returned at ten o'clock, 
with intense headache, thirst, and nausea ; pulse 100, 
small and tremulous ; very much alarmed. Apply a 
blister between the shoulders : continue the powders and 
mixture as yesterday. Vespere — no change ; the bowels 
are acting well ; dark fetid dejections. Midnight — I was 
summoned by a captain of another vessel, with whom the 
patient was intimate, and who requested I would imme- 
diately go down to Captain P , for he thought him 

in a dying state. 

The pyrexia at this time was severe ; great pressure at 
the praecordia. Begged for cold water, and requested 
that he might be left alone with the nurse and his cabin- 
boy to sponge his body and keep it cool ; he always found 
relief from this process. 

19th. — When I saw him at eight o'clock this morning, 
his friend informed me, that from the hour I left him he 
had never ceased talking for one moment, constantly 
giving directions about his vessel and cargo. He com- 
plained of an uneasy fulness and tension in the abdomen ; 
he had vomited dark green fluid ; this, he said, prevented 
him going on regularly ; after taking a draught of the 
solution of nitrate of silver, he was more composed ; but 
declared he would take no more physic : " What good 
can physic do to a dying man?" His pulse 100, very 
small ; tongue dark, but moist ; his eyes and countenance 
have a terrific expression ; his enormous whiskers, and the 
dark yellow hue of the skin and conjunctiva, have entirely 



BILIOUS REMITTENT FEVER. 



121 



altered his appearance ; so much so, indeed, as his friend 
declared, that he would not have been able to recognise him, 
if he had not seen him early and watched the progressive 
metamorphose. The gas evolving from the body, when he 
turned on his side, was extremely disagreeable, and the 
pungent feel of the skin equally so. Allowed him mixed 
hock and beef tea. Enema ; every second hour warm 
fomentations and frictions ; with camphorated castor oil, 
over the whole abdomen. Vespere — says that he is easier, 
" but it is only delusive." The heat of the skin is mode- 
rating, but the odour is very offensive, and the discharge 
from the blisters remarkably so ; tongue very brown, and 
red at the sides ; pulse 100, small; bowels free; dejections 
less offensive; the nurse, during my absence, had pre- 
vailed upon him to take two ounces ol. ricini. 

20th. — Had some sleep ; retains everything which is 
given to him. Apyrexia ; pulse 90 ; tongue the same in 
appearance as last night ; the whole body had been 
sponged with a decoction of pimento leaves, several times 
during the night, by the nurse. 

21st.-— Had slight chills last night, and fever supervened, 
which continued three hours ; he was then covered with 
perspiration, and slept afterwards. Apyrexia ; tongue 
assumes a better appearance ; pulse 90, small but regular ; 
is able to sit up for a short time. Continue the wine and 
quinine. 

22nd. — Had a good night ; is much improved in every 
respect. 

23rd. — Better : no return of fever ; took exercise in a 
chaise in the evening. 

24th. — Discontinued attendance. 

H P , aged 30; an Irishman, delicate habit, 

sanguine temperament; has hitherto enjoyed excellent 



122 



BILIOUS REMITTENT FEVER. 



health during the three years he has been in the country. 
He is (although not an intemperate man) occasionally 
fond of indulging in more spirits than agrees with him. 
Complained this morning, July 2nd, of rigors, languor, 
headache, fainting, moving unsteady pains, thirst, heat, 
and constipated bowels. Pulse 100, firm ; eyes red and 
watery ; tongue foul; temperature of body 104°, under the 
axilla 106°; enema, warm bath, and cathartic pills. 

3rd. — Medicine operated freely, headache gone, apy- 
rexia from midnight till six a. m. ; he had just recovered 
from the rigor on my arrival at eight o'clock ; the tem- 
perature under the axilla was 106° ; the skin was pungent 
and hot ; tongue very deeply coated with ash-colour fur ; 
pulse 100. Cold applications to the surface ; calomel and 
James's powder, with saline draughts, every second hour. 
Vespere — pyrexia violent, stomach irritable ; has not taken 
his medicine. 

4th. — From the hour of two till eight this morning the 
skin has been alternately dry and moist ; excessive thirst 
and headache ; less irritability of the stomach ; tempera- 
ture 105°. Continue the medicine, &c, as yesterday. 

5th. — Remission for two hours last night, but in other 
respects I see no alteration. 

6th. — All night, he says, he was tormented wit n chilly 
fits and burning fever ; great thirst, headache, and rest- 
lessness ; tongue foul ; pulse 100 ; bowels open ; skin hot 
and moist ; no vomiting. Continue the remedies as yes- 
terday. Vespere — violent pyrexia ; stubborn, violent, and 
irritable; refuses everything. Continue the cold applica- 
tion ; apply a large blister between the shoulders. 

7th. — Remission from two o'clock ; he says he is easier ; 
no alteration in the appearance of his tongue, his eyes, or 
the skin; bowels freely evacuated, dark vitiated bilious 



BILIOUS REMITTENT FEVER. 



123 



dejections; pulse 98 ; temperature under the axilla 106°. 
Continue as yesterday. 

8th. — A similar night to the fifth — never slept ; 
pyrexia, with the same symptoms as the sixth. 

9th. — Passed a very bad night ; pyrexia not so violent ; 
tongue still very foul ; pulse 98 ; skin slightly tinged 
yellow, very disagreeable to the touch. Continue. 

10th. — No rigors last night, had some sleep ; apyrexia ; 
bowels open, very black dejections. Gave wine and qui- 
nine during the remission. 

11th .Apyrexia; very weak. Continue the quina. 
12th. — Went into the country, (a few miles from the 
town,) or the sea-coast. 

18th. — Returned to town this morning, in consequence 
of being attacked last night with rigors, fever ; he is 
dreadfully agitated ; muscular tremor pervades the whole 
body ; he is unable to remain quiet for a moment ; head- 
ache and thirst more than usual ; pulse 100, small and 
tremulous ; greatly alarmed at his present feelings ; asked 
for a warm bath and the cold applications ; the tempera- 
ture during this paroxysm, at twelve, two, and four 
o'clock, varied between 106° and 107°; at the last-men- 
tioned hour the skin was very hot to the feel ; tongue 
loaded ; and the colour of the whole body nearly of a 
bright yellow. Resume the calomel and James's powder, 
with saline draughts. Vespere — no alteration. 

19th. — No alteration, pyrexia urgent. Vespere — remis- 
sion at four o'clock, but the fever returned at seven, with 
headache ; great pain in the region of the liver ; eyes 
fixed, pupils dilated. Head shaved, and a blister applied ; 
fomentations to the seat of pain for one hour, then, if not 
relieved, put on a blister. 

20th.— Pyrexia all night ; never spoke a word, and with 



124 



BILIOUS REMITTENT FEVER. 



much difficulty was prevailed upon to take anything ; 
pulse this morning (nine o'clock) 100, small; tongue 
nearly the colour of coffee ; thirst great ; skin hot, and of 
a bright yellow ; the blister rose well, and he is free from 
headache and the pain in the liver; temperature 107°. 
Continue the remedies. 

21st. — No remission ; ideas wandering ; bowels open. 

22nd. — Had several watery evacuations during the 
night ; towards morning a sudden collapse came on as he 
left the night-chair; he was roused by stimulants; pulse 
100, weak and tremulous: tongue darker, and deeply 
loaded, red at the sides ; low delirium. One o'clock p.m. — 
I was sent for in great haste in consequence of another 
alarming collapse : at this moment, although placed in his 
bed, he is convulsed ; eyes void of expression ; counte- 
nance cadaverous ; pulse at the wrists scarcely to be felt : 
cold clammy sweat; has vomited all the fluid and the 
medicine given to him since the morning. Warm mulled 
wine and brandy was directed ; hot warm blankets to cover 
the body. Vespere — more animated, but still insensible ; 
pulse 100, very weak. 

23rd. — Symptoms this morning more favourable; py- 
rexia returned about midnight ; skin is hot and dry, and 
the extremities the same ; pulse easily felt at the wrists 
and the ankles ; eyes and skin very yellow ; temperature 
105°; evacuations dark and fetid; great prostration, in- 
clined to coma ; cannot speak. Vespere — pulse 120, like 
a thread ; perfectly incapable of being roused ; extremely 
tremulous ; eyes, when open, fixed and void of expression ; 
skin hot and moist, mottled blue and yellow ; breathing 
hurried. Blisters between the thighs. Midnight — appa- 
rently feels the blisters ; his hands have frequently been 
placed in the direction ; had several involuntary stools ; 



BILIOUS REMITTENT FEVER. 



125 



countenance pale, shrivelled, and ghastly. Continue the 
wine and quinine. 

24th. — Little or no alteration, although the nurse said 
he replied to questions after I left him. Extremities 
rather below the normal temperature; pulse 100, small; 
cannot produce his tongue. Vespere— no improvement; 
blisters between the thighs : discharge freely a deep yellow 
coloured fluid ; eyes fixed and vacant. 

25th. — Skin and extremities rather warmer ; tempera- 
ture under the axilla 104° ; a very disagreeable odour 
from the body ; when roused or shaken, he opens his eyes ; 
pulse 100. Continue the wine and quinine. Vespere — 
extremities cold and clammy ; ideas sufficiently collected 
to give a direct answer ; in other respects the same as in 
the morning. 

26th. — His appearance is more favourable this morning ; 
extremities are warmer and not clammy, skin warm and 
moist; had several hours natural sleep ; his ideas wander, 
but he is more sane, and can discriminate between the 
glasses which contain the wine and the medicine ; 
pulse 96. 

27th. — Again relapsing into a comatose state ; pulse 
96, rather firmer ; trunk and extremities natural tempera- 
ture ; he gazes about in a vacant and horrid manner, as if 
he perceived or was in search of something ; will occa- 
sionally give rational answers to questions ; tongue nearly 
black; dry and sharp at the apex ; dejections during the 
night more natural and less fetid. Continue the wine and 
quinine ; the blistered parts look red and healthy. 

28th. — Passed a quiet night ; inclined to delirium ; he 
mutters unintelligible sounds ; pulse 90, weak ; skin va- 
riegated in patches, blue, green, and yellow ; temperature 



126 



BILIOUS REMITTENT FEVER. 



100°. Vespere — delirium more violent; skin alternately 
dry and moist ; refuses everything. 

29th. — In constant motion all night; perfectly uncon- 
scious ; pulse 90, easily compressed. 

30th. — Another restless night; gentle ptyalism ; invo- 
luntary stools ; takes wine and gruel ; pulse 90 ; delirium 
continues. 

31st. — Delirium ; the attendants had great difficulty to 
keep him in his bed ; incessantly talking all kinds of non- 
sense ; face, neck, and breast covered with vesicles ; 
countenance and eyes more the appearance of death than 
living ; pulse scarcely to be felt. 

August 1. — Constant motion all night ; drinks nothing but 
barley-water with Madeira wine : quite insensible to sound. 

2nd. — Had a better night than usual ; his ideas are still 
confused ; great debility and emaciation ; tongue swollen ; 
gentle ptyalism ; vesicular eruptions continue to appear 
in successive crops ; eyes and skin intensely yellow ; 
pulse 96 ; temperature 102° ; drinks nearly a bottle of old 
Madeira daily. 

3rd. — No return of pyrexia; but it is evident from 
existing symptoms there is effusion on the brain; still de- 
lirious, but not violent , countenance has a peculiar ex- 
pression,approaching to idiotism ; pupils alternately dilate 
and contract, sometimes there is strabismus of the right 
and then of the left eye ; although in this deplorable state, 
he will frequently answer questions correctly, but in a 
very hurried and unusual manner; great prostration of 
strength ; pulse 84 ; skin naturally warm. Vespere — no 
change. Directed small doses of acetate of morphine with 
camphorated mixture to be given every second hour, until 
one grain and a half was taken. 



BILIOUS REMITTENT FEVER. 



127 



4th. — Very quiet all night, and remains so ; ptyalism 
more copious, the pillow was quite wet before morning ; 
eyes and the expression of his countenance as before de- 
scribed on the 3rd. 

5th. — Has asked for food, and, for the first time since 
the 18th ultimo, has sat up in his bed unassisted. 

7th. — Passed a quiet night ; takes everything which is 
given to him ; ptyalism moderate. 

8th. — Had a slight return of pyrexia this morning, but 
at this hour, ten o'clock, is in a perspiration ; bowels 
open ; tongue cleaning ; pulse 90, soft and regular ; skin 
and eyes yellow; occasional strabismus. Continue the 
wine, quinine, and soda-water. 

9th. — Passed a good night, is able to sit up ; bowels not 
open ; composed and rational. Vespere — sent for in con- 
sequence of his having complained of spasms in the 
bowels. Ordered infusion of senna with sulph. magnesia. 

10th. — The aperient mixture relieved the bowels; 
strength and intellect improving. 

11th. — Is a little better. 

12th. — No complaint, except debility. 

13th.— Idem. 

14th. — Idem. 

15th. — Idem. 

16th.— Idem. 

17th.— Idem. 

18th. — Strabismus this morning, which continued some 
hours ; the yellow tinge of the skin and the eyes less 
yellow. 

19th. — Is better. Was able to leave his bed on the 25th. 

This was one of the most extraordinery cases which I 
had witnessed during the epidemic of 1825. From the 



128 



BILIOUS REMITTENT FEVER. 



time of his first attack until the 25th of August, it com- 
prised a period of fifty-four days. The symptoms through- 
out were of the most alarming description. 

On the evening of the 19th, I dreaded, from the ap- 
pearance of the eyes, which were fixed and immovable, 
some serious affection of the brain ; and from that day he 
became delirious, and continued so until the 4th of 
August, with the exception of some brief intervals of 
reason. The temperature, however, never exceeded 107°, 
it was 106° in the first paroxysm, 106° in the second, and 
on the 4th of July, at eight in the morning, it was 105° ; 
again, on the 7th it was 106° ; and, after this time, the fever 
assumed the intermittent type. 

In the paroxysm after his relapse, when he returned to 
town, the temperature varied during the day between 106° 
and 107° ; at four o'clock on the 18th July, the skin was 
so extremely hot and disagreeable, the attendants de- 
clared that the wet cloths applied to different parts of the 
body dried immediately. It continued at this limit until 
the evening of the 21st. 

On the 22nd he was seized with collapse, and I really 
considered his recovery hopeless. 

The temperature after this period sank to 105° on the 
23rd; on the 25th it was 104°; on the 28th it sank to 
100°. This might have been considered very favourable, 
had not the delirium kept up, and the other unfavourable 
symptoms, such as the colour of the skin, involuntary 
stools, and the easily compressed pulse. 

On the first of August he was quite deaf ; this is one of 
the most alarming symptoms, and I could not hold out to 
his friends the least hope of his recovery ; indeed, if I 
had suppressed all my own fears as to the result, they 
must have been, and indeed were 3 convinced in their own 



BILIOUS REMITTENT FEVER. 



129 



minds, from the death-like appearance of his countenance, 
he would soon be numbered with the dead. 

The sequel was as extraordinary as unexpected. 



FEBRIS INTERMITTENS. 

January 30th. — - B. G , aged 26 ; full plethoric 

habit ; very intemperate, has been drinking hard the last 
three nights ; complains of great pains in the small of the 
back and extremities, severe headache, nausea, and vomit- 
ing ; face much flushed, eyes red and watery : great throb- 
bing of the carotid arteries ; skin hot and dry ; respiration 
quick. All these symptoms were preceded by ague of 
three hours' duration. His pulse is 112, full and strong ; 
has much thirst ; tongue dry and furred : strength much 
depressed ; bowels constipated. 

Fiat venassectio statim ad Jxxx in balneum tepidum. 
Hydrarg. submur. gr. x, statim sumendus ; applicet. lotio 
frigid, capiti. 

Vespere — Obtained relief after the bath and bleeding, 
but says the headache has returned as severe as before ; 
has now considerable excitement, with anxiety and rest- 
lessness ; temperature of the system, the hand grasping the 
bulb of the thermometer, raised the mercury to 103°; the 
heat of trunk at different parts 102° and 103°, under the 
axilla 104°. Continue lotio frigid. ; rep. hydrarg. submur. 
grs. x. 

31st. — Rested well last night ; headache entirely gone : 
skin warm and moist; pulse 80 ; medicine acted freely. 
R. 01. ricini 5ij, statim sumendus. 

Feb. 1st. — Had a return of ague, equally severe as the 

K 



130 



BILIOUS REMITTENT FEVER. 



first attack; it was ushered in by vomiting of bilious fluid 
in great quantities ; the sickness subsided during the rigor ; 
finding the temperature of the system 104° under the 
axilla, although in the cold stage of the fever, as he was 
a plethoric young fellow, it was determined to follow Dr. 
Mackintosh's recommendation, and he was accordingly 
bled to twenty-four ounces. Vespere — apyrexia ; the 
hot stage of the fever went off at four o'clock ; he is now, 
eight o'clock, free from headache and thirst ; bowels 
open ; tongue cleaning ; pulse 86. 

R. Ext. rhaei., sulph. quina aa9j. ut fiant pil. duodecim, 
dividendum, quarum sumat duo secundis horis. 

2nd. — Apyrexia ; says he is weak, but in other respects 
feels quite well. 

3rd. — Had a return of rigor last night, but not of long 
duration ; the hot stage followed ; ere daylight he was 
free from fever. Continue the pills. 

4th. — Free from complaint ; had a good night ; says his 
appetite is good. Continue. 

5th. — No return of rigor or fever. 

6th. — Convalescent. 

Feb. 1st. — James M'D ; is a Scotchman ; five years 

in the island ; phlegmatic temperament and irregular 
habits ; complains of violent headache, pain in the small 
of the back, throbbing at the temples, ringing in the ears, 
and general soreness ; pulse 96, full and hard ; heat of 
surface not above the natural standard ; skin moist; tongue 
white ; no feeling of nausea ; bowels constipated two 
days. 

R. Hydrarg. submur. ext. colocynth, c. aa grs. x. ; ol. 
crotonis, m. ij. ; divid. in pil. iv. ; capiat unam omni hora. 
Two p.m. — Head still much affected, although the 



BILIOUS REMITTENT FEVER. 



131 



bowels have acted freely ; skin hot and dry ; much thirst ; 
tongue the same as in the morning ; temperature under 
the tongue 104°, temperature under the axilla 104°. 

Hab. balneum tepidum ; fiat venassectio ad jxxiv. 
R. Pulo. jacobiae gr. v. submur. hydrarg. gr. iii. ; ft. pulv. 
statim sumendus ; appl. lotio frigid. 

Vespere — has had several dark fetid dejections; pain 
in the head much less severe ; skin still hot and dry ; 
pulse 96. 

2nd. — Passed a very restless night, is better this morn- 
ing ; had epistaxis during the early part of the morning ; 
bowels open ; tongue cleaning ; pulse 90 ; skin hot and 
moist; temperature 103j°. Vespere — complains of slight 
headache. Apply a blister to the nape of the neck ; repeat 
the powder. 

3rd. — States that he was yawning and stretching almost 
the whole night, and was unable to compose himself in 
any position ; the fever came on at seven o'clock, preceded 
by headache and constant vomiting for one hour ; what- 
ever he drank he instantly rejected. Repeat the powder 
every second hour with saline draught. Skin is hot and 
dry, (now nine o'clock;) temperature under the axilla 104°. 
Vespere — pyrexia continues ; has less headache, but ex- 
cessively thirsty; soda-water occasionally ; bowels acting 
well ; no vomiting. 

4th. — Slept well last night ; feels very well this morn- 
ing ; has no febrile excitement ; tongue clean ; pulse 80. 

5 th. — Is able to dress himself. 

8th. — Discharged. 

February 10th. — John Cochrane, aged 25 ; spare make, 
sinewy, but very active ; sanguine temperament ; red 
hair. Admitted with cold shiverings, vomiting, and pains 
all over the body ; tongue foul ; pulse 100 ; bowels costive ; 

k 2 



132 



BILIOUS REMITTENT FEVER. 



skin hot and dry; temperature under the tongue 105°, 
under the axilla 103°; temperature of the blood, as it 
flowed in a rapid stream into the bleeding basin, exactly 
105-25 ; he was in a tepid bath when he was bled. 
Cathartic pills, saline draughts. Vespere — considerable 
heat of surface, especially about the head and neck ; stools 
nearly black, very fetid. 

11th. — Bowels freely open ; skin soft and cool; slept a 
little towards morning. Vespere — pyrexia returned at six 
o'clock, with headache and thirst ; complains of twitchings 
in the tendons and muscles of the legs. 

12th. — Slept well, no fever to-day ; complains of great 
weakness. Quinine and wine ; pil. extract, colocynth. c. 
gr. vj. ter in die. 

18th. — Pulse firm and regular; no return of fever. 
Discharged to the convalescent ward. 

John M'G , aged 21 ; two years in the country ; 

admitted yesterday, March 3rd, with the cold stage of 
fever ; says he has often had it, and it has gone off with- 
out much annoyance ; has been attacked with it occa- 
sionally during his nightly duty on guard, but as it never 
lasted long, he took no notice of it, nor should he have 
come to the hospital to-day if Lieutenant Matson had not 
sent him. He is of florid complexion, active and sober ; 
pulse this morning, 4th, 110 ; tongue white ; skin hot and 
dry ; no nausea ; free from headache ; has pain in the 
back and legs; temperature 103°. Tepid bath, cathartic 
pills. Vespere — no fever ; bowels freely acted upon. 

5th. — Ague came on about two o'clock this morning, and 
continued four hours. Vespere — dry skin ; quick pulse ; 
tongue clean and dry ; considerable thirst ; bowels slow ; 
descendat in balneum calidum. 
R. Hydrarg. submur. gr. iv. ? pulv. jacobise gr. iii., pro 



BILIOUS REMITTENT FEVER. 



133 



dosis statim sumend., et repetatur secunda quaque 
hora. 

6th. — No fever this morning ; slight ague in the after- 
noon. 

7th. — Ague of the quotidian type to-day, not severe. 

12th.— He had a slight daily attack of fever until this 
day, which passed off without any complaint; he took 
daily about twelve grains of sulphate of quinine, which 
did not affect the head. 

March 7th. — P. W. C , aged 22 ; came to the hos- 
pital this morning with ague, which, he states, comes on 
every morning, and remains for three hours; feels the 
approach of the cold stage at this moment; pulse 100, 
small ; tongue foul ; eyes very red ; much headache ; was 
bled to twenty ounces. Tepid bath, cathartic pills. 

8th. — Cold stage of ague at eight o'clock this morning ; 
he has vomited freely; and the bowels have been re- 
lieved ; temperature under the axilla in the cold stage 
104°. 

9th. — Ague came on again last night, which prevented 
him from sleeping ; he is now bathed in cold clammy per- 
spiration. Give quinine and wine. 

10th. — Vespere — Has had no ague to-day. Continue 
the quinine and wine. 

11th. — Ague returned at eleven o'clock, which lasted 
until two o'clock p. m. 

12th. — No ague. 

13th.— Idem. 

14th.— Idem. 

18th. — Discharged to duty. 

Such cases as the preceding are frequently met with on 
the north side of the island, from the month of December 



134 



BILIOUS REMITTENT FEVER. 



to the end of April. Of late years, since the general use 
of the sulphate and muriate of quinine, intermittent fever 
is seldom of long duration. It is a medicine of inesti- 
mable value, if judiciously administered, particularly with 
children and young females, who are very subject to 
quotidian fever in the fall of the year, which is sometimes 
very obstinate. 

The temperature of the system, which I consider of 
paramount importance, in the six cases of which the 
symptoms and treatment are detailed, never exceeded 
105°, but the general average of the whole taken in the 
first paroxysm — 

In B. G , at different parts, 103° 

James M'D , „ „ . 104° 

J. C , „ „ . 1040 

Ditto, of the blood, . 105j° 

John MG , at different parts, 103° 

P. W. C , cold stage, . . 104° 

Mean temperature, 103 J. 

With this temperature we have nothing to dread. 

August 14th. — Robert B , a Scotsman, aged 24, 

a mason by trade ; four years in the service, two of which 
he has been in Jamaica ; of middle stature ; plethoric 
temperament; is canteen man to the detachment. Ad- 
mitted this morning, with febrile symptoms: complains 
chiefly of painful headache ; internal throbbing sickness 
at the stomach, and thirst of three days' duration ; skin hot, 
but moist ; tongue furred; pulse frequent and full ; respi- 
ration free and natural. No pain of loins or abdomen. 
Says that the pain of the head is not so severe as the 
throbbing is disagreeable ; bowels open ; much dejection 



BILIOUS REMITTENT FEVER. 



135 



of spirits. Is also afflicted with gonorrhoea, which he 
says is of ten days' standing, and states that he suffers no 
inconvenience from it but the discharge. Vespere — 
symptoms have become more acute ; heat of surface 
much increased, by thermometer 108°; pulse 120, strong 
and full. Bled in a warm bath to thirty-six ounces: 
syncope followed as he was being placed in bed. The 
cathartic medicine operated well. 

15th. — Passed a restless night, but states he is much 
relieved since morning : headache much less severe ; 
pulse 112, soft; skin moist; tongue w T hite ; still thirsty; 
occasionally vomits what he takes, mixed with very green 
bile ; pain at the prsecordia. 

Applicet. vesicator. empl. epigastric Solut. argent, 
nitrat. minim, decern, omni bihorio. Omittatur pil. 
purgans. 

Vespere — has had no accession to-day ; states that he 
has no complaint ; bowels open ; tongue less foul ; no 
vomiting. 

16th. — Appears improved this morning ; slept a little 
during the night ; stomach quite easy and retentive. 
Vespere — an increase of fever has taken place ; skin hot 
and dry ; pulse quick and weak ; thirst urgent ; occa- 
sional efforts to vomit ; headache and drowsiness ; bowels 
slow ; tongue white ; temperature under the axilla 108°. 

17th. — Was extremely restless all night ; fever con- 
tinues, with drowsiness ; went to the night-chair three 
times during the night ; pulse 90, rather weak ; skin 
parching, hot, and dry ; tongue white and coated. Ves- 
pere — there is no perceptible change in the symptoms 
since morning ; the fever continues. 

Applicet. empl. lyttsB inter scapulas. Continue the 
solution, enemataque. 



136 



BILIOUS REMITTENT FEVER. 



18th. — No rest last night; pyrexia continues; bowels 
freely open ; drowsiness almost amounting to stupor ; 
pulse 110. Vespere — pyrexia continues ; has slept during 
the greater part of the day ; is less drowsy this evening ; 
says he is quite free of pain ; has no other disagreeable 
sensation except a constant desire to drink some cold 
fluid, and implored he might be indulged with water, if 
only a wine-glassful at a time ; pulse 96, rather stronger 
than in the morning. 

Repetatur pilula cathartic, secundis horis ; cum haustu 
salin. Allowed soda-water. 

19th. — Passed a better night; slept soundly towards 
morning; heat of surface considerably diminished ; skin 
slightly moist ; temperature under the axilla 106° ; 
bowels open twice ; pulse 86 ; tongue still blanched. 
Vespere — pyrexia continues, but less violent; thirst 
continues; pulse 100, firm; free from acute pain, but 
describes his situation as wretched in the extreme : he 
says he is conscious of being free from pain ; yet he is 
totally unable to help himself, or sit up for ^nore than one 
or two minutes 

R. Submur. hydrarg. Pulv. jacobiae ; pulv. camphoras, 
aa. B j : divid. in part, sequales iii. Capiat unam secunda 
quaque hora. Continue the saline draughts. 

*20th. — Became delirious last night, and still continues 
so ; mutters continually to himself ; eyes dull, pupils 
dilated ; countenance pallid and inanimate ; respiration 
slow but regular; pulse 100, weak; tongue dry and 
brown ; teeth encrusted ; lips parched ; skin clammy ; 
heat of surface not above the natural standard ; tempera- 
ture under the axilla 106°. 

Abradat. capillos capiti, et applicet. empl. lyttse. Con- 
tinuetur medicamentum. 



BILIOUS REMITTENT FEVER. 



137 



Vespere — blister on the head rose well ; has been quiet 
all day ; is still delirious, but does not talk so much : in 
other respects the same as in the morning. 

21st. — Has passed a pretty good night; had some sleep, 
and appears better to-day ; heat of skin natural ; tempera- 
ture under the axilla 103°; pulse 90; tongue cleaning; 
countenance more cheerful ; eyes bright and more ex- 
pressive ; bowels freely evacuated. Very weak wine and 
quinine; discontinue the powders. Vespere — has been 
doing well all day ; but the heat of the skin has increased 
since morning ; no other unfavourable symptom. He 
answers questions rationally. 

22nd. — Slept well after midnight ; tongue moist, and in 
appearance more natural ; complains of debility ; a total 
loss of muscular power. Continue the wine and quinine. 
Vespere — no change. 

23rd. — Still doing well, but is unaccountably weak. 

24th. — Better; gradual convalescence. 



POST MORTEM EXAMINATION OF GEORGE ANTHONY, ROYAL 
FOREIGN ARTILLERY, 28TH JULY, 1815. 

The stomach was found uncommonly contracted, and a 
considerable portion of its inner membrane inflamed ; on 
the outer and upper surface it was found to show a num- 
ber of small vessels, and, upon cutting into it at this part, 
it was somewhat thicker. The duodenum was slightly 
tinged ; yet, on tracing the whole contents of the intes- 
tinal canal, nothing worthy of observation was presented. 



138 



BILIOUS REMITTENT FEVER. 



The peritoneum was partially inflamed, and adhesions 
were found firmly attaching it to the parts of the viscera 
on the right and left sides. The omentum was healthy. 
The liver was carefully detached and examined ; it was 
uncommonly hard, so much so, as to be with some diffi- 
culty cut into : small tubercles were found in almost every 
part ; its weight was nearly nine pounds. A little water 
was found in the cavity of the thorax, and the left lobe of 
the lungs adhered very firmly to the pleura. 



Page 139 




MEDICAL TOPOGRAPHY. 



MILITARY STATIONS. 
UP PARK CAMP AND KINGSTON. 

In a military point of view, a casual observer would 
readily grant that the situation of Up Park Camp is ad- 
mirably adapted for a garrison. It is something more than 
a mile and a half from the Metropolitan Church of Kings- 
ton, the road to which rises gently on an inclined plane 
of about 200 feet from the level of the sea. Enter the 
walls of the garrison on which side you will, the whole 
view and arrangement of the different buildings for the 
accommodation of the officers and men is really and truly 
an imposing scene ; and why any objection can be made 
to it as an unfit position for the location of troops, by 
persons unacquainted with the facts, appears remarkable. 
And yet the casualty return of every regiment stationed 
there within the last twenty years is, of itself, sufficient 
proof, if none other could be produced, that it is so. I am 
aware of the opinious which induced the government to 
fix upon this site for the erection of barracks. If there 
was nothing else in existence at the present day to con- 
trovert those opinions, the frightful mortality, since it has 
been a military station, is more than enough to convince 



140 



BILIOUS REMITTENT FEVER. 



the most sceptical of the party who formed the committee 
to select a spot in every way adapted for a garrison. 
Hence arises the question, is it, or is it not, in every way 
adapted ? 

The buildings occupied by the troops are raised on 
arches, all fronting to the south, looking down on the city, 
embracing an extensive marine view. These barracks are 
better ventilated now than formerly, and consist of three 
ranges : those for the officers, in front ; for the men, in the 
centre ; and for the hospital, in the rear. The barracks 
are of brick, two stories high ; the hospital of the same 
material, but of one story and a basement, with balconies 
all round. Within the last few years an extensive bath has 
been built, and is well supplied with excellent water from 
the river, which flows through the Hope Estate, no great 
distance from the camp. The troops have the advantage 
of this bath, and there can be no doubt it has very 
considerably added to their health as well as to their 
comfort. The garrison is bounded on the east by a 
mountain ridge of no great altitude, which is called the 
Long Mountain, which stretches round the camp towards 
the north, until it is nearly lost in the well-cultivated plain 
of Liguanea. Not a great distance to the westward part 
of the basin of the harbour runs ; the land about it is low 
and swampy, which is also the case in the neighbourhood 
of Rock Fort, and more to the eastward is a pond which 
is a source of malaria. If we regard the direction of the 
trade-wind as it strikes the island, we may be able to 
form some idea what influence it may have on the health 
of the soldiers. The sea-breeze, whilst it continues in the 
east and south-east points, strikes on the east end of the 
island, and is divided in its current, passing in curved 
lines along the two opposite coasts of north and south. 



BILIOUS REMITTENT FEVER. 



141 



When the sun approaches the northern tropic, the sea- 
breeze declines more southerly, and then follows the sun's 
track, only varying a few points in the course of the day : 
this is observable from the month of June to the end of 
the year. When the sun rises north-east, the breeze sets 
in from the same quarter ; and as the former continues its 
progress, the latter will apparently diverge to the south, 
until the sun sets in the north-west. 

The weather and the temperature of the atmosphere 
differ essentially on the south and north sides of the island ; 
the whole district of the city and parish of Kingston, 
and the plain of Liguanea, are throughout the year, wdth 
but little exception, very dry, the rainy periods being 
May and October ; but of late years these seasons have 
not been very regular. The oldest inhabitants remark, 
that so long as the weather is dry, they have little to 
dread on the score of sickness ; but when the weather is 
variable, alternating between rainy and sultry days, then 
the whole district more or less is sickly ; the pens and 
residences skirting the harbour towards Rock Fort par- 
ticularly so, and Rock Fort and its neighbourhood are dan- 
gerous to dwell in. There are in this spot, and to 
windward of it, morass, ponds, and low, uncultivated 
land: the east-south-east wind, passing over these one-half 
of the year, will have a baneful influence on every resi- 
dence into which the malaria enters ; and that it does 
enter would be folly to question. It has been asserted 
that malaria cannot travel far from the place of its pro- 
duction ; a fallacy often leading to serious consequences. 
The east wind has the power of transporting it to con- 
siderable distances. One half of the year Up Park will 
only receive the breeze from this quarter ; the malaria 
may or may not be diluted before it reaches the garrison, 



142 



BILIOUS REMITTENT FEVER. 



but it is sufficiently potent to create or augment the force 
of fever, when a less injurious exciting cause may be 
in existence, as Captain Tulloch remarks with respect to 
the pernicious quality of the rum made use of by the 
soldiers. 

Malaria will originate in towns and barracks, nay, 
in ships ; a contrary opinion has often led to gross 
neglect, not only in the treatment of diseases, but in the 
use of proper precautions against its effects. H. M. Ship 

, lying at Port Royal, about two years ago, 

became very sickly, the cause of which was not easily 
ascertained until after the vessel had undergone a 
thorough overhaul and purification, when it was dis- 
covered that some prepared cases of meat had become 
decomposed, and created sufficient malaria to affect a great 
number of the crew. I mention this as worthy of remark, 
to point out to the proper officer in every military es- 
tablishment, that he cannot be too particular with regard 
to removing every possible nuisance either in or out of 
the garrison. There are a great many invisible agents at 
work for the destruction of human life in all tropical 
countries ; and therefore it becomes a paramount duty 
with every one who possesses the ability, to remedy the 
evil by every possible means. I am disposed to believe a 
great quantity of vegetable matter often lodges at the foot of 
the Long Mountain, which, if in a state of decomposition 
from heat and moisture, will prove a fruitful source of 
disease, particularly in the autumnal months. 

Wherever men are lodged, in whatever building, it is of 
primary importance that their sleeping apartments be 
sufficiently ventilated, and at least six feet from the 
ground ; the barracks should be built on pillars or arches, 
so that a current of air may pass through in all directions; 



BILIOUS REMITTENT FEVER. 



143 



the places underneath the flooring should be flagged or 
bricked, and kept perfectly dry and clean. Simple as this 
precaution may appear, it is of more importance than most 
persons are inclined to believe. 

With regard to effluvia causing fever on board ship, a 
remarkable instance is recorded by Mr. Hartle in his ac- 
count of the yellow fever on board the Pyramus frigate, 
which arrived in Kingston harbour from Barbadoes, on the 
3d of January, 1822. 

One of the principal reasons assigned for the breaking 
out of the disease was, that this ship had been " injected 
with coal-tar, which, with bilge- water, caused remarkable 
effluvia. The only ships injected with coal-tar were the 
Pyramus, the Esk sloop of war, and Dasher transport, 
all of which suffered, the former and latter especially, 
with a similar type of disease, yellow fever in its most 
malignant form." He states that the crew of the Pyra- 
mus were landed, and the ship dismantled. When the 
limber boards were removed, the effluvium from the hold 
surpassed anything which he had " ever before experi- 
enced." A boatswain looking into the hold from the 
lower deck, while an inspection by proper officers was 
going on, fainted, and passed afterwards through a for- 
midable attack of the disease. Mr. Hartle states that 
every individual present at the opening of the holds and 
limber boards was attacked by the prevailing disease. 
Although the frigate had been only six months from Eng- 
land, and was believed to have been a short time out of 
dock, four large mud-boats of filth were removed from her 
at Antigua, which was nine inches in depth in the hold. 
The negroes employed in removing this mass were 
obliged to go on deck occasionally, so insufferable was 



144 



BILIOUS REMITTENT FEVER. 



the stench, and three of them had the characteristic dis- 
ease. 

Such facts as these should be kept in mind by the 
commanding officers of land and sea forces ; the health 
of the men under their command should be their first 
consideration ; without health discipline is a nullity ! A 
want of attention and neglect of the organic laws has cost 
many a man his life, in every part of the world. When, 
therefore, we know the penalties of infringement, it is 
a species of madness to neglect them. Captain Murray, 
R.N., states, that in his opinion most of the bad effects 
of the climate of the West Indies might be avoided by 
care and attention to clothing and cleanliness ; and so sa- 
tisfied w T as he on this point, that he petitioned to be sent 
there in preference to the North American station. The 
Captain wTites thus : — " I attribute the good health en- 
joyed by the crew of H.M. ship Valorous, when on the 
West India station, during the period I had the honour 
of commanding her, to the following causes : — 

<c 1st. To keeping the ship perfectly dry and clean. 

" 2nd. To habituating the men to the wearing of flannel 
next the skin. 

" 3rd. To the precaution I adopted of giving each man 
a proportion of his allowance of cocoa before he left the 
ship in the morning, either for the purpose of watering, or 
any other duty he might be sent upon. And, 

"4th. To the cheerfulness of the crew. 

"I was employed on the coast of Caraccas, the West 
India Islands, the Gulf of Mexico. I visited Trinidad, 
Margarita, Cocha, Cumana, Nueva Barcelona, Laguira, 
all the West India Islands from Tobago to Cuba, also 
Curacoa and Aruba, and several of these places repeatedly ; 



BILIOUS REMITTENT FEVER. 



145 



also Vera Cruz and Tampico ; yet I arrived in England 
on 24th June, without having buried a single man or 
officer belonging to the ship, or indeed having a single 
man on the sick list. 

The following tables and remarks are extracted from 
Major Tulloch's Statistical Report on the Sickness, Mor- 
tality, and Invaliding, among the Troops in the West 
Indies ; presented to both houses of parliament, by 
command of her Majesty, in 1838 : 









Ratio of deaths 


Years. 


Strength. 


Deaths. 


per 1,000 of 








mean strength. 


1817 


1,392 


115 


83 


1818 


1,171 


76 


65 


1819* 


914 


458 


501 


1820 


728 


117 


160 


1821 


1,113 


145 


130 


1822* 


379 


168 


443 


1823 


269 


22 


82 


1824 


582 


26 


45 


1825* 


607 


207 


341 


1826 


445 


32 


72 


1827 


867 


195 


225 


1828 


480 


57 


118 


1829 


509 


22 


43 


1830 


609 


73 


120 


1831 


691 


76 


no 


1832* 


725 


66 


91 


1833 


652 


51 


78 


1834 


690 


48 


70 


1835 


840 


44 


52 


1836 


857 


44 


51 


Total. 


14,520 


2,042 




Average. 


726 


102 


140-6 



From this table, then, it appears, that the mortality has, 
on the whole, been considerably above the average of the 
island ; and, on some occasions, so fatal did this station 

* Epidemics. 



146 



BILIOUS REMITTENT FEVER. 



prove to the troops, that in 1819 and 1822 nearly a half, 
in 1827 about a fourth, of the garrison were swept off. 

The diseases whereby the mortality in each year has 
been occasioned, are detailed in Abstract No. 14 of 
Appendix, whereof the totals for the whole period have 
been arranged in classes as follow : 



By Fevers .... 
Eruptive Fevers 
Diseases of Lungs 
" Liver 

" Stomach and Bowels 

" Brain 
Dropsies .... 
All other diseases 

Total 





Ratio of deaths 


Total deaths 


annually 


in 20 years. 


per 1,000 of 




mean strength. 


1,754 


120-8 


3 


•2 


124 


8-5 


11 


.8 


84 


5-8 


30 


2- 


11 


•8 


25 


1-7 


2,042 


140-6 



From this it appears that the principal source of mortality 
at this station, beyond what prevails elsewhere throughout 
the island, is fever, of which it experienced several ex- 
tremely fatal epidemics : the particulars of these we shall 
now proceed to detail. 

The 50th regiment was sent to this station : on its 
arrival in the island, in March 1819, and the 92nd 
regiment, on its arrival in June following. In the early 
part of that year, the epidemic, or yellow fever, had 
shown itself, to a considerable extent, both here and at 
Port Royal, and, at the end of June, several cases ap- 
peared in these newly arrived corps. As it was supposed 
this might have been occasioned by their being over- 
crowded, detachments were sent to Stoney Hill, Fort 
Augusta ; but, notwithstanding this precaution, by the end 



BILIOUS REMITTENT FEVER. 



147 



of July the fever had increased, and continued to rage 
with such appalling violence during the greater part of 
August, that scarcely a man of either corps escaped being- 
attacked by it, and nearly one half their number perished. 
The garrison was then entirely broken up and removed to 
Stoney Hill, Fort Augusta, and his Majesty's ship Serapis, 
sufficient only being left to take charge of the stores. 
In the middle of November, the troops were landed from 
the Serapis, and the garrison re-assembled from Fort 
Augusta and Stoney Hill. The disease continued, but 
with diminished virulence, till the end of December, when 
it disappeared at this station. 

That this disease spared neither age, sex, nor condition, 
is pretty evident from the following abstract of the deaths 
caused by it, in each corps, at this and the other stations 
to which they were sent in the course of the year : 



592nd Foot., 


Strength. 


Died. 


50th Foot. 


Admitted. 


Died. 


Commissioned officers. 


27 


10 


Commissioned officers' 


30 


11 


Officers' wives 


5 


4 


Soldiers 


769 


231 


Soldiers 


650 


275 


Soldiers' wives 


90 


30 


Soldiers' wives 


60 


29 


Soldiers' children . 


50 


33 


Soldiers' children . 


70 


38 









We cannot furnish the strength of each class in the 
50th regiment, nor the admissions of each class in the 
92nd regiment ; but the above is sufficient to establish 
that all suffered in nearly an equal degree. The pro- 
portion of admissions to deaths was about one in three, 
and the number of admissions considerably exceeded the 
whole strength, so that several must have been attacked 
twice. 

l 2 



148 



BILIOUS REMITTENT FEVER. 



That advanced age, hardy constitution, or previous ser- 
vice in a warm climate, had no effect in counteracting the 
operation of this disease, is sufficiently apparent from the 
fact that the 92nd regiment, composed of hardy veterans 
who had served through the Peninsular campaign, suf- 
fered considerably more than the 50th, composed, with 
the exception of forty, of young men recently enlisted. 

Though several detachments of both corps were sent 
from this station to Stoney Hill between July and October, 
the disease did not manifest itself there till November, 
and then did not prove quite so fatal as at this station. 

The greater part of that year was exceedingly sultry ; 
there was a want of the usual supply of early rains, and 
the country is described as being much parched up when 
the fever broke out ; but the changes of temperature or 
moisture, which took place during the months in which 
it prevailed, seem to have had no perceptible effect in 
diminishing either its prevalence or intensity. 

In the latter end of 1821, and beginning of 1822, the 
epidemic fever prevailed among three companies of the 
50th regiment at this station to so great an extent, that 
about a fourth part of them was cut off. No detail is 
given of the circumstances under which it commenced, 
or of the state of the weather at that period, from which 
we may conclude there was nothing remarkable in either. 
In July these companies were marched to Stoney Hill, to 
make way for the head-quarters of the 33rd and 9 1st 
regiments, then just arrived from England, who immedi- 
ately began to fall victims to the same fatal disease ; for 
between their arrival and the middle of May, when they 
were all removed from the station, the number attacked 
nearly equalled the whole strength of the garrison, and of 
these one hundred and fifty-live died. In this instance. 



BILIOUS REMITTENT FEVER. 



149 



too, it was strikingly exemplified that neither age, sex, 
nor condition, could boast of any exemption, as will ap- 
pear from the following details : — 



the 33rd lost 

4 Officers out of 21. 

8 Women out of 57. 
17 Children out of 74. 
67 Soldiers out of about 250. 

There were four companies at Stoney 
Hill out of the range of the epide- 
mic. 



THE 91ST LOST 

4 Officers out of 20. 

8 Women out of 71. 
10 Children out of 62. 
88 Soldiers out of about 350. 

There were two companies at Stoney 
Hill out of the range of the epi- 
demic. 



This epidemic prevailed also to a considerable extent 
at Spanish Town and Port Royal, but for its effects there 
we must refer to the returns of these stations. 

The fever of 1825, which cut off a third part of the 
troops at this station, did not originate here, but seemed 
rather to have been a sequence of that which broke out 
with such violence at Stoney Hill, and prevailed so 
generally throughout the island. The principal circum- 
stance worthy of remark, in regard to it, was, that at 
Stoney Hill it broke out about the middle of February, 
after a long continuance of dry sultry weather, when the 
ground was excessively parched, and as the drought in- 
creased, so did the disease ; whereas at Up-Park Camp 
it broke out in the month of June, after the rains had 
commenced, and continued with unabated severity during 
a period when more rain fell than had been witnessed for 
twenty years previous, and as the rain increased, so did the 
disease. 

The epidemic of 1827, by which about a fourth part of 
this garrison was cut off, commenced at Fort Augusta, 



150 



BILIOUS REMITTENT FEVER. 



where it raged with great violence, during the month of 
August, and subsequently extended itself to Up -Park 
Camp. The particulars of its origin and progress will be 
found in the details of Fort Augusta. 

The other diseases at this station offer no peculiarity 
worthy of remark, being much the same as the general 
average throughout the island. 

As early as the month of March, in the year 1835, the 
yellow fever appeared on board H.M.S. Vestal, then lying 
in Port Royal harbour, and was attributed to the continu- 
ance of the north and north-east winds blowing directly 
over the lagoons by Fort Augusta and Port Henderson, 
carrying with it miasma, which was engendered by the dry 
weather preceding that period. 

The Dee (steamer) also became unhealthy, and such 
was the state of the vessels that they were ordered out of 
Port Royal harbour, and anchored to leeward of one of 
the neighbouring quays, away from everything which could 
engender sickness. 

In the city of Kingston it also prevailed to a great ex- 
tent, as will be seen by the following remarks on the 
health of the city, which I have extracted from the 
Jamaica Physical Journal for the month of August: it is 
from the pen of a friend of the editor. 

"During the last four months we have had in succession 
two prevailing diseases — influenza and yellow fever. 

" The influenza, a disease which prevailed some time 
ago in Europe, found its way to our remote land, and at- 
tacked all indiscriminately. The white and the dark 
races, the new and the old European residents, were all 
equally subject to its power : and, fortunately for us, this 
power, in most cases, was exercised with a light hand.. 



BILIOUS REMITTENT FEVER. 



151 



The disease, generally speaking, was a mild one, and 
passed off in two or three days without leaving any bad 
effects. In most cases, it appeared as a common severe 
cold or catarrh, but attended with more fever. It came 
on with redness, and watering of the eyes, thin discharge 
from the nose, headache, heat of skin, quickness of pulse, 
cough, pains in the chest, sometimes very acute ; soreness 
over the body, and a feeling of great weakness. In some 
cases, there was a rash on the skin, and there were 
several cases where inflammation of the throat and tonsils, 
ending in superficial ulceration, were the principal symp- 
toms. 

" The milder forms of this affection yielded readily to 
purging ; the severer required the use of the lancet, anti- 
monials, and blisters. The important symptoms arose 
from bronchial inflammation ; and in those where the dis- 
ease was neglected at the beginning, this proceeded to an 
alarming point, and ended in chronic bronchitis, or 
in the death of the individual. Such severe forms, we 
believe, were rare. There were two fatal cases which 
came under our notice. One ended in chronic bronchitis, 
which at first appeared to be subsiding gradually, when 
an affection of the intestines ending in ulceration super- 
vened ; and the bronchial affection rapidly disappeared. 
The intestinal disease continued and terminated in the 
death of the patient ; in the other, the patient was cut off 
in four or five days, by acute bronchial inflammation ; he 
had severe fever, incessant cough with mucous rale, 
dyspnoea, and acute pain in the side. He was a drunkard, 
and appeared to have been drinking rum, when in the 
state we have described ; he was treated by depletion, as 
far as circumstances would admit ; but the symptoms in- 
creased, and in two days more the features were pinched, 



152 



BILIOUS REMITTENT FEVER. 



the pulse flagged, he had frequent attacks of syncope, 
the inspirations were short, but not laborious ; for several 
hours before his death, there was a profuse sweat from 
his head and face, which was dropping down on his hands 
in such quantity as we had never before witnessed in any 
disease. The cough had now disappeared, and he as- 
sumed a sitting posture, but his breathing did not seem 
much laboured, though short and catching. There was 
another form of this influenza, in which there was no 
bronchial affection, nor any redness of the eyes, nor dis- 
charge from the nose ; but after a few hours of malaise, 
and weariness or pain in the back and legs, fever came 
on, sometimes with a slight chill ; the pains in the back 
and legs increased, and had also attacked the shoulders 
and arms down to the fingers, and there was an intolerable 
sensation of soreness, apparently in the muscles, all over 
the body ; there was severe headache, with considerable 
disorder of the stomach and liver. Its duration was from 
one to three days, and when it subsided, it left the body 
very weak, and subject to occasional slight febrile acces- 
sions. 

" In some cases, as we have seen from the above descrip- 
tion, the malaria operated as a direct irritant on the 
mucous membrane of the air passages, and excited in- 
flammation there ; in others, there appeared to be only a 
morbid impression made on the extremities of the nerves 
on the mucous surface, which was conveyed to the nervous 
centres, from which it was transmitted along the nerves 
of sensation to all parts of the body. The course of the 
pain in the arms was that of the nerves, and at their ex- 
tremities in the points of the fingers there was a distressing 
sensation of pain, heat, and tingling, which continued for 
some hours after the accession of the disease. This affec- 



BILIOUS REMITTENT FEVER. 



]53 



lion differed from the epidemic called, oddly enough, 
' dandy fever,' which prevailed all over the West Indian 
Islands in 1828, inasmuch as the pain in the latter was 
seated in the fibrous or serous membranes of the joints, 
and especially in those of the ankles and wrists. 

" It had been well for our community, had no worse evil 
befallen us, than the disease we have described; but 
scarcely had this disappeared when the yellow fever gave 
warning of its approach, and during the last two months 
we have had it amongst us attacking almost every Euro- 
pean who has not been seasoned to the climate by a 
residence of some duration. Young men in the flower of 
their age, little fearing the danger that awaited them, have 
scarcely set foot on shore, when they have been attacked 
by this fever, and in a few days are numbered with the 
dead. Others, who had resided six or eight months in 
this town, and who had hitherto enjoyed good health, and 
who had begun to think themselves secure, are suddenly 
surprised by fever, and are brought to the brink of the 
grave, or are laid low in the abode of death. During the 
last six or seven years yellow fever has been almost un- 
known, and we, with others, had hoped that the climate 
had undergone some change that was unfavourable to its 
origin and existence ; but the last few weeks have shown 
us, that our exemption was but a truce, and that we have 
again to contend with this fever as marked, as irremediable, 
and as mortal, as ever. 

" Yellow fever is supposed to have two different sources : 
1st. The high temperature acting on the peculiar condi- 
tion of a body recently brought from a cold to a tropical 
climate, aided by any of the exciting causes of fevers ; 
such as exposure to cold and wet, fatigue, and stimulating 



154 



BILIOUS REMITTENT FEVER. 



food, and fermented liquors. From this source is the 
sporadic disease — the inflammatory endemic. 

" 2nd. The malaria, miasm, a something in the air, or 
some change in the combination of the component parts 
of the atmosphere, which acts as a morbific cause on the 
unchanged system of the European. It has been proved 
that an emanation, probably a gaseous matter, highly in- 
jurious to the human body, and capable of producing the 
most mortal fevers, escapes from vegetable matter in a 
state of decomposition under a high temperature; and 
when this process is going on in confined places, where 
the temperature is even higher than that of the atmo- 
sphere within the tropics, such as the lower part of the 
hold of a ship trading or cruising in the West India seas ; 
this emanation has become so concentrated, that the 
persons employed in cleaning the hold have been almost 
instantly seized with the most violent symptoms, followed 
by the severest form of yellow fever. We thus see that a 
matter generated by decaying vegetable matter is capable 
of producing yellow fever; but whether such is always 
the nature of the malaria that engenders yellow fever, we 
think has never been ascertained. That there is, at 
times, a something in the air that operates as a poison on 
the body of man when he comes from a cold region to 
this island, cannot be doubted ; but the origin and nature 
of this poison is unknown ; the circumstances that favour 
Us production, even the sensible atmospheric changes 
that aid or check its formation, are not at all understood. 
Moisture and tropical heat, with dead vegetable matter, 
are said to be sufficient for its production in the open 
air; but we could not help remarking, that the yellow 
fever had appeared in this town before the May rains had 



BILIOUS REMITTENT FEVER. 



155 



fallen, and that it continued its course, unaffected by the 
additional moisture and the cooler atmosphere that came 
in the train of these welcome seasons. The long exemp- 
tion we have had from the disease has shown us how 
little mere climate, without malaria, has to do with its 
origin. The climate in the West Indies varies little — one 
year is like another, and six or seven years have elapsed 
without our having met with more than one or two cases 
of yellow fever ; and in the present year, the climate ap- 
parently remaining the same, every new European resi- 
dent is affected. An additional cause is therefore in 
operation ; we know not what it is, we know it comes 
from the earth, but in what manner we cannot tell, nor 
how; if it proceed from the decomposition of organic matter, 
it should differ from the usual products of such decomposi- 
tion in having no sensible properties, nor any even that the 
splendid operation of modern chemistry can detect. 

"We would not, from these observations, be understood as 
doubting the existence of an inflammatory endemic, aris- 
ing from the effect of high temperature and common sti- 
muli, on the unseasoned constitution of the European. 
We have often met with such a disease amongst the sea- 
men in this port, and we have considered that it destroyed 
life by the excitement, the inflammations, and the conges- 
tions which result from the violence of the vascular 
action. The other form, the malarious fever, may termi- 
nate fatally by inducing similar lesions, and the symptoms 
will be modified according to the organs thus affected. 
But there are cases where the commotion in the system 
is so moderate, that we cannot ascribe their fatal termi- 
nation to lesions of this description ; besides, the symp- 
toms of the fever do not indicate that any organ is in a 
state of actual inflammation or congestion. In such cases, 



156 



BILIOUS REMITTENT FEVER. 



the nervous system appears to be acted upon as if by 
some powerful sedative. There is great prostration of 
strength from the beginning, or the patient at first may 
feel little change in this respect ; but, from the beginning, 
his pulse is weak and easily compressed, and the abstrac- 
tion of a few ounces of blood will bring on syncope. In 
two or three days, the pulse and heat come down to the 
natural state, and even fall below this : and certainly the 
pulse, at this period, is always much below the frequency 
which characterizes it, when the body is much debilitated 
by other forms of fever. In the progress of the disease, 
it soon appears that the power which the nervous system 
imparts to the blood-vessels, of preserving the blood in its 
vital state, is lost, and that the united action of blood- 
vessels and blood is dissolved. Under these circumstances, 
the blood escapes into the tissues, or, altered in its pro- 
perties, passes into the vessels carrying colourless blood, 
by which are caused those haemorrhages, morbid secretions, 
congestions, and disorganizations, that are witnessed in 
the closing scene of this terrible disease ; they are the 
effect of the poison which has a destructive action on the 
powers of life, independent of the organic lesions. 

" We have seen, after three days of an apparently mild 
fever, (in which we could not say there was any organ 
particularly affected,) the skin assume a lemon colour, 
the pulse fall and continue for a short time nearly natural ; 
in a few hours more we have seen the breathing quick, 
the pulse so weak as scarcely to be felt, and at this time 
the face, which had been previously pale, has become in 
a few minutes as red as scarlet, and the previous slight 
redness of the eye so increased as to resemble that organ 
in acute inflammation. In this case there were two or 
three slight convulsions, but, in the intervals, perfect con- 



BILIOUS REMITTENT FEVER. 



157 



sciousness. The disease lasted ninety-six hours, and the 
individual had arrived in this country from England six 
days only before he was attacked. Here we may say 
that we actually saw the passive congestion taking place. 

" The disease had appeared in Port- Royal Harbour 
some time before any case was met with in this town. 
One at length appeared in the lower part of the town, 
and after a short interval other cases occurred in different 
parts of the streets ^bordering on the sea-beach, and on 
the wharfs. In these situations there were many persons 
recently arrived from a cold climate, and subject to its 
attack. Besides several individuals from England resid- 
ing in this quarter, there were a number of German immi- 
grants that had arrived in December, 1834, from Bremen. 
These were domiciled on wharfs, and of course close to 
the sea. Though it is natural to suppose the yellow fever 
would break out in that situation where the greatest num- 
ber of unseasoned Europeans were living, yet other causes 
might perhaps be found for its appearance first in the 
lower part of the town. The houses there are more 
crowded together, the temperature is therefore somewhat 
higher, and the ventilation less perfect ; and from the 
gentle declivity on which the city stands, and the torrents 
of rain which run down the streets, the animal and vege- 
table matter of the upper parts of the town, and the adja- 
cent country, which is a gradual slope from the base of 
the mountains to the level of the sea, is carried down to 
the lower streets, and to the beach and the sea-ground 
around the wharfs. 

" If such matter be the source of malaria, it is easy to be 
understood how, when thus accumulated and acted upon 
by decomposing causes, it should give forth malaria in 
greater quantity, and more concentrated form than might 
yet have existed in other parts of the city. The other 



158 



BILIOUS REMITTENT FEVER. 



parts, however, were not long exempted ; and we believe 
this fever has been met with in every quarter where the 
materiel was to be found on which it could exert its 
evil influence. 

" In one house in North-street, which is the highest and 
most healthy locality, four cases of ardent fever had their 
origin ; three of which were of great severity, and one of 
these was fatal. There have been, as yet, very few cases 
in Liguanea — in Spanish Town there have been some 
cases amongst the civilians, and the disease is now pre- 
vailing in the 8th regiment stationed there, and, as is usual 
when it gets amongst large bodies of men, there has been 
great mortality ; two officers have died. We have little 
doubt the step which has been adopted, of removing the 
men from the spot where the disease broke out, and the 
placing them under canvass, will give a check to its 
farther ravages. 

We have spoken of the liability of the European; but 
it w T ould appear that the resident of the Northern States 
of America is not more safe, though the climate of his 
summer is that of the tropics, and his country has been 
often very severely visited by the yellow fever. Several 
individuals have lately arrived here from these States, and 
some of them have been attacked, and we are sorry to 
understand that two or three have died. As this fearful 
disease still exists amongst us, we would recommend all 
who are liable to its attack to leave the town, and look 
for a temporary residence in the higher mountains, where 
they may remain safe amidst the mortality that exists 
around them. When the present yellow fever first ap- 
peared, it was of a highly inflammatory character, and 
of the continued form ; at present, as far as our experience 
goes, the stage of excitement is less violent, and in most 
cases there are evident remissions. We have not found? 



BILIOUS REMITTENT FEVER. 



159 



as yet, that the remittent form is more safe for the patient 
than the others — the remissions are very incomplete, and 
of short duration, and afford us no evidence that the 
morbific cause is not gradually producing its specific 
effects, the second stage of the disease. 

<tf In one case that had come on as a paroxysm of inter- 
mittent, and where from this circumstance we expected a 
favourable event, we were sadly disappointed. The 
patient had gone to bed quite well, and awoke at three in 
the morning with his teeth chattering, and a general rigor ; 
the hot fit soon followed, and in the afternoon of the same 
day he had a profuse sweat, with general relief : in short, 
a well-marked paroxysm of intermittent. Fever returned 
in the course of the night, and there was no second inter- 
mission, but during the progress of this case we observed 
two imperfect remissions. It proved fatal also in ninety- 
six hours from the coming on of the rigor, and in its close 
was a strongly marked case of yellow fever." 



PORT ROYAL. 

This town is built at the south-west extremity of a 
narrow sandy peninsula, about ten miles in length, which 
runs across the harbour of Kingston, and protects it from 
the sea. The ground in the vicinity of the town is a 
perfect level, often covered with water during heavy rains 
or high tides, and the soil is of gravel and sand. Its 
nearly insular position secures free ventilation and a 
reduced temperature rarely subject to sudden alterna- 
tions. The sea-breeze coming direct from the ocean is 
Tsry refreshing, and the land-wind having to pass over 



160 



BILIOUS REMITTENT FEVER. 



that tract of salt water which forms the harbour of Kings- 
ton ere it can reach the station, is nearly equally so. 
Comparatively little rain falls here, and from the nature of 
the soil it is readily absorbed. 

The barracks stand at the very extremity of the penin- 
sula on which the town is built, only three feet above the 
level of the sea, and frequently at high water a great 
portion of the parade-ground is iuundated by the tide. 
The hospital is in a narrow street leading from the 
town to the barracks, and consists of a ground floor and 
upper story divided into six wards, with balconies front 
and rear. 

The mortality among the troops at this station during 
the last twenty years, has been as under : — 









Ratio of deaths 


Years. 


Strength. 


Deaths. 


per 1000 of 








mean strength. 


1817 


254 


10 


39 


1818 


200 


10 


50 


1819 


272 


86 


316 


1820 


257 


15 


58 


1821 


262 


59 


225 


1822 


278 


57 


205 


1823 


312 


26 


83 


1824 


250 


25 


100 


1825 


293 


94 


321 


1826 


234 


22 


94 


1827 


283 


44 


155 


1828 


281 


5 


18 


1829 


268 


22 


82 


1830 


283 


42 


148 


1831 


237 


8 


34 


1832 


156 


5 


32 


1833 


257 


10 


39 


1834 


205 


22 


107 


1835 


252 


9 


36 


1836 


234 


2 


9 


Total 


5,068 


573 




Average 


254 


29 


113-1 



BILIOUS REMITTENT FEVER. 



161 



Thus, during the above period, the average mortality 
has been about 113 per thousand of the strength annually ; 
but it exhibits remarkable variations at different periods. 
Last year it was less than one per cent, while, in 1825, 
about a third part of the force was cut off ; thus demon- 
strating how difficult it is to form any fair estimate of the 
influence of these climates, except on the average of a 
long series of years. This station suffered very severely 
from the epidemic fevers which raged throughout the 
island in 1819, 1822, and 1825. A large proportion of 
the force also was cut off in 1821, when most of the other 
stations were comparatively healthy. 



FORT AUGUSTA. 

This Fort lies about four miles from Kingston, and nearly 
an equal distance from Port Royal ; it is built on the ex- 
tremity of a low neck of land or peninsula, forming the 
north-west boundary of Port Royal Harbour, and almost 
surrounded by the sea. In the vicinity, indeed almost 
under the very walls of the Fort, is an extensive marsh 
or lagoon, through which the river Cobre, a sluggish 
stream, empties itself. This marsh is interspersed with 
several small islets covered with mangrove bushes, and 
abounding in every species of decayed vegetation, from 
which issue most offensive effluvia w 7 hen the wind comes 
from that quarter. 

The soil of the peninsula is sandy, and has a coral 

M 



162 



BILIOUS REMITTENT FEVER. 



formation for its base; the barrack consists of a stone 
building two stories high, but not arched or raised from 
the ground, owing to which, it is said, a larger proportion 
of sick comes from the under story. The hospital is built 
in the lowest part of the Fort, and is liable to the same 
defect of not being raised from the ground. 

The atmosphere of Fort Augusta is rather more humid, 
but the heat, as shown by the thermometer, is much the 
same as at the other stations in the vicinity, though, from 
its nearly insular position, less liable to sudden alterna- 
tions. The Fort enjoys the advantage of a pure and regu- 
lar sea-breeze from nine in the morning till six in the 
evening, when the land-wind commences, and continues 
till six in the morning ; there is then generally a cessa- 
tion of both, during which period it is sultry and op- 
pressive. 

Prior to 1832, this garrison furnished a detachment of 
two companies for the duty of Kingston, from which the 
sick were sent to the Fort ; it has therefore been necessary 
during that period to include the strength of this detach- 
ment, along with that of the garrison, in the following 
Table of the mortality : — 



BILIOUS REMITTENT FEVER. 



163 









Ratio of deaths 


Years. 


Strength. 


Deaths. 


per 1,000 of 








mean strength. 


1817 


440 


15 


34 


1818 


518 


17 


33 


1819 


300 


31 


103 


1820 


325 


30 


92 


1821 


384 


17 


44 


1822 


369 


19 


51 


1823 


476 


15 


31 


1824 


527 


43 


81 


1825 


368 


21 


58 


1826 


494 


30 


61 


1827 


526 


147 


280 


1828 


439 


37 


84 


1829 


369 


26 


70 


1830 


642 


27 


42 


1831 


403 


32 


79 


1832 


165 


4 


24 


1833 


233 


13 


56 


1834 


313 


16 


51 


1835 


213 


15 


70 


1836 


282 


17 


60 


Total 


7,786 


572 




Average 


389 


29 


73-5 



The deaths, as shown by this table, have averaged 73j 
per thousand of the strength annually; but this, though 
so much lower than the general average of the island, is 
greatly beyond what is attributable to the climate of Fort 
Augusta. Kingston, to which the detachment before 
mentioned has been furnished from this garrison, is one 
of the most unhealthy quarters in the island ; and a very 
great portion indeed of the deaths recorded in the above 
table originated there. We have been able to trace and 
deduct not fewer than fifty-six of these in the year 1825 
alone, but in none of the other years could we effect any 
accurate separation, and can therefore only recommend it 
to be kept in view, that the two companies at Kingston 

m 2 



164 



BILIOUS REMITTENT FEVER. 



always furnished more fatal cases than the four which 
were at Fort Augusta, and, with the proper correction on 
that principle, the mortality there cannot have exceeded 
five per cent, annually. Though its locality is apparently 
so unfavourable, Fort Augusta has, long antecedent to the 
date of this Report, been esteemed one of the healthiest 
stations in the island. Taking the average of four years 
and a half, between 1789 and 1794, the mortality was as 
low as three per cent. ; and with the exception of one year, 
1827, it has almost uniformly maintained that healthy cha- 
racter ever since. 

The mortality by fever, even including the large pro- 
portion from Kingston, is only half the general average of 
the island. While the epidemics of 1819, 1822, and 1825, 
were raging in the vicinity, this station in a great measure 
escaped their influence, and it was only by that of 1827 
that it suffered severely. The 84th regiment arrived here 
in February of that year, and enjoyed such a remarkable 
degree of health, that only one death took place in the 
whole corps in six months ; but, in July, fever began to 
show itself among them, without any apparent cause to 
induce it, except that the barracks were rather crowded at 
the time. In the hope of checking its progress by better 
accommodation, a part of the corps was sent to Up-Park 
Camp, and this change at first seemed to have a good 
effect ; but, towards the middle of August, sickness rapidly 
increased, and numbers daily became its victims. The 
Fort was then evacuated, and the troops moved to an en- 
campment at Airey Castle, a few miles off, which had 
some effect in checking the disease ; but unfortunately 
wet boisterous weather set in, the tents were blown down, 
and the sick being exposed for several hours to its in- 
clemency, twenty of them perished in one night; tern- 



BILIOUS REMITTENT FEVER. 



165 



porary huts were afterwards erected, and so soon as the 
troops were comfortably accommodated in them, the 
disease disappeared. During the short time it continued 
at its height, it proved more rapidly fatal than on any 
previous occasion, 112 having been cut off out of about 
300, in the short space of one month. When the disease 
abated here, it broke out with renewed violence at Up- 
Park Camp and Stoney Hill, where it proved nearly as fatal. 

After the return of the corps to the Fort, several cases 
again occurred, but at length the disease gradually disap- 
peared. On this occasion there was an apparent exemp- 
tion in favour of the women, children, and officers, only 
about a fifth of them having been cut off, while there were 
about two-fifths of the men ; but so many changes in the 
quarters of the corps took place at this period, that we 
have no means of knowing whether they were all equally 
exposed to the exciting cause of the disease. 

Notwithstanding the equable temperature, diseases of 
the lungs prove considerably more fatal here than at most 
other stations in the island, while those of the bowels are 
proportionably lower ; without there appearing any cause 
to which such pecularities can be traced. 

Out of 572 deaths, only two have occurred by diseases 
of the liver — an extremely low proportion indeed. On 
such a large range of numbers, this is not likely to have 
been the effect of chance, and we may therefore safely 
conclude the climate of this station to be highly favourable 
to recovery from such diseases. 



SPANISH TOWN. 

This town, the capital of Jamaica, lies about five or 
six miles distant from the sea, and thirteen from Kingston ; 



166 



BILIOUS REMITTENT FEVER. 



it is situated at the eastern extremity of an extensive 
plain, surrounded by mountains on the north and north- 
west, and by uncultivated waste tracts of land on the 
south and west. The mountains to the north approach with- 
in a few miles of the town, and form part of a lofty chain 
intersecting the island, and of great elevation. Those to 
the westward and eastward are a continuation of the same 
range, but less elevated, and form gentle undulations to 
the southward, where they run into the plain. The town is 
said to be extremely dirty, badly drained, and, whether 
from that or its situation, the inhabitants are at all times 
very subject to febrile diseases. The Cobre, a sluggish 
river of considerable depth, passes at the distance of about 
a quarter of a mile. The soil in the immediate neighbour- 
hood, which is of a clayey tenacious nature, is barren and 
unproductive, and after heavy rains produces partial 
swamps. The country as far as the foot of the mountains 
being a dead level, and no artificial means employed to 
cany off the superabundant moisture, it remains until 
evaporated by the sun's rays, and when the land-winds 
blow over the ground thus saturated, they are supposed 
to have considerable influence in the production of fevers. 

The sea-breeze, which tends so much to modify the 
heat at other stations, is here very irregular ; indeed from 
August to October it is often scarcely perceptible ; the 
temperature during the day is consequently much higher 
than at the other stations ; but at night a cold wind sets 
in from the mountains, which often reduces the thermo- 
meter ten degrees in the course of a few hours, and, 
though pleasant, causes too rapid a transition to be bene- 
ficial to the constitution. 

The barrack at this station consists of a brick building 
about two hundred feet in length by forty in breadth, and 



BILIOUS REMITTENT FEVER. 



167 



three stories high, the two upper ones divided into rooms 
for the soldiers, with separate accommodation at each end 
for the non-commissioned officers, the lower one unoccu- 
pied. The hospital is also of brick, two stories high, the 
under one used for stores, the upper divided into wards, 
with a surgery and offices at either end ; the whole en- 
closed by a high wall, which serves to confine the men to 
barracks, # but of course has the disadvantage, in a 
crowded town, of materially impeding ventilation. 

The troops quartered here have been extremely un- 
healthy, and that not in occasional years only, but almost 
uniformly, as will appear by the following Table : — 









Ratio of deaths 


Years. 


Strength. 


Deaths. 


per 1000 of 






mean strength. 


1817 


352 


45 


128 


1818 


262 


73 


278 


1819 


352 


24 


68 


1820 


318 


87 


273 


1821 


450 


41 


91 


1822 


433 


105 


242 


1823 


275 


55 


200 


1824 


290 


60 


207 


1825 


361 


144 


399 


1826 


269 


50 


186 


1827 


371 


61 


164 


1828 


364 


30 


82 


1829 


389 


20 


51 


1830 


363 


45 


124 


1831 


297 


70 


236 


1832 


353 


20 


57 


1833 


403 


27 


67 


1834 


309 


48 


155 


1835 


258 


50 


194 


1836 


250 


36 


144 


Total 


6,719 


1,091 




Average 


336 


55 


162-4 



* These barracks are decidedly bad, and unfit for the accommodation of 
troops ; they cannot be otherwise than unhealthy. 



168 



BILIOUS REMITTENT FEVER. 



Thus the mortality, during this period, has averaged 
162 per thousand of the strength annually ; on no less 
than seven different occasions, between a fourth and fifth 
part of the whole force was cut off in the course of the 
year, and in 1825 the ratio of mortality amounted even to 
two-fifths of the strength. 

This station has always been remarkably fatal to Euro- 
pean troops ; even so far back as 1780 its extreme insalu- 
brity was pointed out and commented on by the medical 
authorities, who stated that at least a third part of the 
garrison died annually. From estimates which have been 
made of the relative salubrity of the different stations, 
founded on some old returns, between 1794 and 1797, it 
appears at that period also to have been the most un- 
healthy station in the island, except Montego Bay. 



STONEY HILL. 

This post is situated about nine miles from Kingston, 
on a lofty eminence in the Liguanea Mountains, 1360 feet 
above the level of the sea, commanding the grand pass 
which there intersects the island from north to south. 
The hill on which the barracks are built is flat on the top, 
and lies between the ends of two high mountain ridges, 
that in the south-east upwards of 3000 feet high, the 
other, on the west, considerably lower. The parade and 
buildings occupy a space of twenty acres ; the barracks 
consist of three detached stone buildings of two stories 
each, erected on small eminences, with a basement below 
to secure them from the damp, and verandahs on the 



BILIOUS REMITTENT FEVER. 



169 



south front. The hospital is a quadrangular stone build- 
ing on the east of the barracks, and consists also of two 
stories, on a basement, with two smaller buildings for 
offices at each angle, and a verandah in front and rear ; 
there are two wards in the upper, and two in the lower 
stories for the patients. 

To within the distance of a few hundred yards the 
garrison is surrounded by brushwood, which gradually 
rises into thick standing wood ; the soil is for the most 
part of a reddish clay mixed with sand, but, from the 
elevated nature of the ground, the rain never lodges in 
any quantify, and there are no marshes or swamps in the 
vicinity. About a mile to the east runs a small stream, 
from the banks of which generally rises at night a dense 
fog, producing an unpleasant dampness, but not supposed 
otherwise hurtful. 

At mid-day there are only a few degrees difference in 
temperature between this and the low grounds, but it is 
liable to more sudden alternations, and the nights are 
much more cold and damp. The thermometer in the hot 
months is generally 74 at six o'clock a. m., 82 at two p. m., 
and 80 at six p. m. ; in the cool months 68, 75, and 73, at 
corresponding hours. The land-wind ceases about nine 
o'clock in the morning, and as the sea-breeze does not 
reach the station till eleven or twelve, the interval is fre- 
quently hot and oppressive. 

The mortality among the garrison, during the last 
twenty years, has been as follows : — 



170 



BILIOUS REMITTENT FEVER. 









Ratio of deaths 


Years. 


Strength. 


Deaths. 


per 1000 of 








mean strength. 


1817 


422 


41 


97 


1818 


296 


11 


37 


1819 


239 


72 


301 


1820 


140 


7 


50 


1821 


400 


18 


45 


1822 


528 


25 


47 


1823 


516 


13 


25 


1824 


471 


14 


30 


1825 


413 


187 


453 


1826 


439 


8 


18 


1827 


477 


137 


287 


1828 


353 


1 o 
ID 


37 


1829 


378 


5 


13 


1830 


342 


6 


18 


1831 


230 


40 


174 


1 ft 39 




1 A 
xt 


TO 


1833 


350 


11 


31 


1834 


316 


11 


35 


1835 


356 


12 


44 


1836 


383 


8 


21 


Total 


7,243 


653 




Average 


362 


33 


90-2 



Thus, notwithstanding the apparent advantages in the 
position of this station, the mortality has averaged 90 per 
thousand of the strength annually ; and though in some 
years it has been as low as in Britain, in 1825 nearly half, 
and in 1819 and 1827 more than a fourth part of the force 
was cut off. 

At the commencement of the epidemic, the troops at 
Stoney Hill did not exceed 418 ; in the month of March, 
200 of these, who had not been attacked by fever, were 
sent to Fort Augusta and Up-Park Camp, where for a 
time they continued healthy. In June, however, in con- 
sequence of the disease having broken out at Up-Park 
Camp, and moderated at this station, those who had been 
sent there returned ; and when it reappeared among them 



BILIOUS REMITTENT FEVER. 



171 



in August, about 100 of the survivors were, as a last 
resource, encamped on the hill, but without any decided 
effect. The disease continued to linger at the station till 
the end of the year, and then seemed only to wear out for 
want of fresh victims. The total number of troops at this 
station does not appear to have exceeded 300, except for 
a few weeks at the commencement of the epidemic, and 
yet of that small number 184 were cut off, and 11 officers 
out of little more than 20, in the course of eight months. 

The epidemic prevailed here principally during the 
months of October and November, after it had ceased at 
Fort Augusta; but there seems to have been no pecu- 
liarity attending it worthy of notice. In 1831 this station 
again suffered from fever, though not to so great an extent 
as on the previous occasions, only about a seventh part of 
the force having died ; it commenced in August, and con- 
tinued till October, when it assumed a milder form, and 
gradually disappeared. During this period, the weather 
was remarkably foggy, with frequent heavy rains ; and as 
it began to clear up, the disease moderated. The pro- 
portion of deaths to admissions on this occasion was about 
one in four, and all classes were alike affected. 

By contrasting the position, mortality, and fatal diseases 
of this station and Fort Augusta, we have a striking instance 
how imperfectly we can appreciate the cause of disease, 
or predicate, with any degree of certainty, whether one 
locality is likely to prove more safe than another. Fort 
Augusta is situated in the midst of a marsh or lagoon, 
abounding with that decayed vegetable matter which is 
supposed a most fertile source of fever, while Stoney Hill 
is 1360 feet above the level of the sea, and free from any 
such cause of disease ; yet the deaths by fever have not 
only been higher than at Fort Augusta, in the proportion 



^72 



BILIOUS REMITTENT FEVER. 



of 70 to 56, but this station has suffered from four severe 
epidemics, while Fort Augusta, though in the immediate 
vicinity of Port Royal, Kingston, and Up-Park Camp, 
where that disease is so prevalent and so productive of 
mortality, has been comparatively exempt from all but 
that of 1827. 

In like manner, were we to be guided by the usually 
received opinions in regard to diseases of the lungs, we 
should have been led to suppose, that in a position so 
elevated, so liable to frequent alternations of temperature, 
and with so damp and foggy an atmosphere as Stoney 
Hill, that class of diseases would create much greater 
mortality than at Fort Augusta, where the temperature is 
so equable, and the situation less exposed to sudden 
atmospheric vicissitudes ; whereas we find the very re- 
verse to be the case, as diseases of the lungs occasion a 
mortality of nine and a half per thousand annually of the 
garrison of Fort Augusta, and but six and a half per thou- 
sand of the garrison of Stoney Hill. 

Having given these details of the principal stations on 
the south side of the island, we shall proceed to notice 
those on the north side, of which the first is Port Antonio. 



PORT ANTONIO. 

The parish of Portland consists of an irregular, square 
figure, bounded on the east by the parish of St. Thomas, 
so called, in the east, and on the west by that of St. 
George ; the northern boundary is the Atlantic Ocean, the 
coast extending about sixteen miles in length, inde- 



BILIOUS REMITTENT FEVER. 



173 



pendent of the prominences and indentations ; and the 
southern line is formed by the loftiest ridges of the Blue 
Mountains. 

The first-mentioned side of the square, or rather rhom- 
boid, is the shorter of the four, being, in a straight line 
from south by west to north by east, scarcely more than 
ten miles. Indeed, to the north of Priestman's River it 
is not so much, but the line of coast continues beyond this 
embrochure, and forms the north-east point of the island 
as well as of the parish. 

The shore is a series of bays and harbours, of which 
those of Port Antonio are by far the most commodious, 
the eastern or windward harbour being secure from all 
winds but the north, and the western affording shelter 
even from that wind. They are perfectly easy of entrance, 
and ships can go out of the eastern harbour, at all times, 
except against a north wind. The sea-breeze, however, 
is not sufficient for getting out of the western harbour; 
but as the land-wind seldom fails, especially in the early 
morning, the exit from this port cannot be considered 
otherwise than as easy. 

The harbour is bounded, to the west, by a morass, part 
of which has been drained and cultivated : its immediate 
proximity to the environs of the town renders it very un- 
healthy, particularly in the autumnal season. The houses 
here are badly constructed, low, ill ventilated, and are 
occupied, for the most part, by free browns and blacks, 
not the most industrious class of inhabitants. During the 
prevalence of westerly winds in autumn, the noxious 
vapours are carried into the very dormitories of these 
people, who, if they escape from severe attacks of febrile 
diseases, are affected by subsequent ailments of a nature 
calculated to render the remainder of their days little 



174 BILIOUS REMITTENT FEVER. 

less than a life of listless misery. Traversing up this 
street, which leads to Harbour-street, there is on the right 
a small square called Market-square ; the lane leading 
from this square to the south is probably one of the most 
filthy places imaginable — the privies, sewers, and drains, 
are badly constructed, although, at very little expense, they 
might be made with sufficient slope to the adjacent har- 
bour to carry off all impurities. 

In the epidemic of 1819, this part of the town was first 
visited by the prevailing fever : it was a dry season, very 
sultry, and the sea-breeze was scarcely felt; the gas 
evolving from the decayed vegetable and other matter 
mainly conduced to render the inhabitants of this part of 
the town very sickly. The houses in Harbour-street form 
a segment of a circle; two rows compose the street 
looking into the harbour ; generally speaking, this part of 
the town is healthy. We want a correct census of the 
population. The epidemic of 1819 made nearly as much 
noise, and created as great a controversy in Jamaica, as did 
that which visited the town of Gibraltar in the year 1828 ; it 
was the severest epidemic ever witnessed, and I believe 
that of Gibraltar was equally so. 

After much controversy among the medical men on the 
spot # as to the cause ; — the number of conflicting opinions 
on the subject of its contagious nature ;— -after a most 
minute inspection by an efficient medical police, its origin 
was clearly and distinctly traced to filth ! Yes, filth ! 
Tremble, ye advocates of imported disease. The in- 
habitants were lulled into the belief that a ship-load of 
contagious gas lay off the port, and a strict quarantine 
was instituted : not a soul on board was suffered to land, 



* At Gibraltar. 



BILIOUS REMITTENT FEVER. 



175 



and persons from the shore were interdicted from all com- 
munication with the dreaded hydra. The fever notwith- 
standing increased daily : the troops in the different bar- 
racks at length became sickly, and in the course of a very 
short period a hundred were carried to the grave. This 
was exactly the case in Jamaica in 1819. The troops 
stationed here seldom exceed 150 men; they have not 
suffered in the ratio which other garrisons have during the 
prevalence of epidemics, although in the year 1819 the 
mortality was great ; before the termination of the month 
of November, twenty men, two women, and three children, 
died at this post; on the south side of the island the 
number of deaths was unprecedented : between the 50th, 
91st, and 92nd regiments, five hundred men died from 
its first appearance, in June, to the end of November 
following. 

The inhabitants in this parish did not become sickly 
until the middle of July ; several old residenters died. 
The shipping were sickly, particularly the men employed 
in boating for produce and wood ; preparatory to the day 
of sailing, on the 1st of xlugust, their work was very 
laborious, and the exposure great. The Bann sloop of 
war arrived here during the prevalence of the fever ; she 
had a few sick on entering the port; the purser and 
several men died. 

From the north-west end of Harbour-street there is a 
hilly road, of easy ascent, which leads to that part of the 
town called Upper Titchfield, which forms a kind of 
peninsula, on the point of which the fort and barracks 
stand. The officers' barrack is an ill-constructed, long 
range of rooms, overhanging the eastern harbour, fronting 
nearly east. The building is neither elegant nor con- 
venient, adequate to the exorbitant sums of money from 



176 



BILIOUS REMITTENT FEVER. 



time to time expended in building and repairing ; it 
possesses, however, one remarkable feature demonstrative 
of the contracted mind of the contractor. 

There are seven apartments about twelve feet square ; a 
verandah, looking into the basin in front, which is divided 
into an equal number of lesser rooms ; there is another 
verandah, looking west, so constructed as to reap all the 
advantage of the afternoon's sun. At the extremity of the 
building, which meets your eye as you enter at the gar- 
rison gate, there is rather a better suite of rooms appro- 
priated for the commanding officer. At the other extreme 
end, fronting the men's barracks, there is a small verandah 
and a mess-room, which is probably the least objection- 
able part of the building; — it must always be disagreeable, 
owing to the lowness of the roof. However, with all 
these disadvantages, in point of comfort, &c, there is 
scarcely an instance known of the death of an officer 
stationed here for a period of twenty years. 

The barracks for the men are excellent, substantial, 
airy, and commodious ; they may vie w ith any in the 
island ; they were built a few years ago at an expense to 
the colony of near 9,000/. The building is so placed as 
to reap all the advantage of the sea-breeze, which is 
uniformly east for the most part of the year. 

The hospital is a superb building ; it embraces every 
requisite, and cost upwards of 6,000/. 

The fort, in front of these barracks, commands the en- 
trance into either basin ; beyond the channel, which lies 
to leeward, is Navy Island, containing about eighty acres 
of land, to whose position the west harbour is indebted 
for its security during the north winds. Leaving the bar- 
racks, the eye is arrested by a variety of houses built on 
this part of the peninsula, which is laid out in streets and 



BILIOUS REMITTENT FEVER. 



177 



lanes, at right angles ; and such is the strange mixture of 
taste displayed in these edifices, that no two are alike 
in size, nor has any regard been paid to elegance or 
uniformity. In all there are about sixteen houses, con- 
taining white inhabitants, with but little exception, 
amounting to about eighty persons. This part of the 
town is very little attended to ; the streets are overrun with 
rank weeds, hordes of wandering negroes' pigs infest every 
avenue, to the great annoyance of pedestrians. It reflects 
the greatest disgrace upon the police regulations of the 
town, or the parochial officers, whose duty it is to keep 
the streets in order. Remove these obstacles, — this part 
of the town is not only picturesque, but proverbially 
healthy : at one time there were many remarkable instances 
of longevity : twelve old ladies, whose united ages 
amounted to (a mother and daughter, 180 years, ten 
others, 790, total) 970, averaging 80 years each. 

The shore encircling the eastern harbour is low and 
swampy, but to no great extent ; the land almost imme- 
diately rises into hills, which are planted with grass, or cul- 
tivated into cane-fields ; the tide, which seldom rises more 
than two feet, is not sufficient to overflow the flats. Some 
portion of these levels are planted with canes, through 
which runs a small river, called the Eastern, and there is 
another which empties itself into the harbour close to the 
town, called Port Antonio River ; on the left bank of this 
stream there are several small houses built by persons 
who hold leases from a corporate body called the Titch- 
field Trust. 

This is a most unhealthy spot ; the land-wind, passing 
over the morass through which the stream flows, carries 
the miasma, undiluted, into these settlements, as well as 
into others in the immediate proximity, which are occu- 

N 



178 



BILIOUS REMITTENT FEVER. 



pied by white inhabitants. The residents here are a 
pallid and unhealthy race, labouring under chronic hepa- 
titis, enlarged spleens, and are subject to frequent attacks 
of cholera. The land adjacent to this part of the town rises 
suddenly into high eminences and ridges, upon which 
are several neat dwellings, said to be very healthy, from 
their great altitude above the level of the sea. 

The principal road through the parish, commencing at 
Priestman's River, extends along the sea-shore westward, 
following the indentations of the coast, to the town of 
Port Antonio, which is in fact a continuation (part of) 
Titchfield, and, continuing westward, crosses the Rio 
Grande above Burlington Estate. The whole district, from 
Priestman's River to the estate called Anchovy Valley, 
about a mile from the town, is justly estimated the most 
healthy part, and less subject to tropical diseases than the 
other divisions of the parish. 

The line then returns to the sea-shore, with which it 
runs parallel until it quits the parish. The only other 
road which is at all passable for carriages, is that which 
enters Portland at its south-east comer, towards the sources 
of the Rio Grande ; it is here called the Cunha Cunha 
Road ; crossing the Carrion Crow Hills from Bath, in the 
first instance, and continuing for some miles along the 
bank of the river, w T hich it at length quits for the Maroon 
town, and thence for Seaman's Valley Estate ; thus far, 
however, it is but a bridle-road. From Seaman's Valley 
it now runs parallel, or nearly so, with the river, for a few 
miles, passing Golden Vale Estate, crosses the river, and 
then takes its course down the vale to Port Antonio. At 
Golden Vale Estate there is a hot medicinal mineral 
spring, of a similar quality to the hot springs at Bath in 
St. Thomas in the East. 



BILIOUS REMITTENT FEVER. 



179 



There is another branch of this road on the left bank of 
the river ; the two unite below Sandy River, and where 
M'Adamized the road is excellent, where it is not 
M'Adamized it is abominable. 

The Rio Grande entering the parish with the Cunha 
Cunha Road at the south, flows in the north-westerly 
course to the sea, and cuts Portland into two nearly equal 
portions, receiving many tributary streams by the way, 
the most important of which are Guava River and Back 
River. These and many smaller streams become im- 
passable during heavy rains, especially Rio Grande itself, 
which, as its name imports, is a very considerable, and in 
floods a very tremendous stream. The whole parish being 
a series of mountains and gullies, hurries down the waters 
received from the heavens with a most rapid, and fre- 
quently a most terrible, impetuosity. The whole of the 
settlements along the left bank of the Rio Grande, and 
along the line of coast westward, are unhealthy : the hardy 
Creoles are tolerably secure, but the Europeans seldom 
escape yearly attacks of the indigenous autumnal fever. 
The flat lands should be better drained. In Italy the 
malaria produces dreadful effects in many places, when 
the unfortunate inhabitants, in vain flattering themselves 
that they have escaped the fever, fall victims to dropsy 
and other diseases, arising from organic derangements ; 
and by parity of reasoning, we find an exact illustration 
in the chronic affection so often met with in the swampy 
districts of this, as well as other parishes, in Jamaica. 
The diseases, when most virulent, have the character of 
remittents ; when less so, they are intermittents, present- 
ing all the variety of quartan, tertian, and quotidian : the 
latter are frequently obstinate, chiefly affecting children 
from the age of three to ten years old. 

n 2 



180 



BILIOUS REMITTENT FEVER. 



Towards the end of the year, in certain districts, malaria, 
of a quality somewhat different, will produce hepatic 
affection and dysentery, frequently very obstinate, the 
latter oftentimes epidemic. Cholera and cholic are occa- 
sionally met with in the vales on the bank of the Rio 
Grande, owing, unquestionably, to the sudden transitions 
from heat to cold, produced by the chilling land-wind 
which blows very strong during the night. I had some 
conversation with a gentleman who resided in this district 
managing a large plantation. He was not a little hurt, that 
I pronounced that the prevailing sickness in the neighbour- 
hood, and at his own residence, was entirely owing to local 
causes, over which the agency of man had no control ; 
it might be mitigated, but never entirely removed. It is 
a beautiful spot. The scenery cannot be surpassed in 
any country ; the cultivation is of the highest order ; a 
transient glance, whilst it delights the eye, bewilders the 
senses of adventurous men, who, intent only upon gaining 
the philosopher's stone, are too often cut short in their 
career, when at the very moment it appeared within their 
grasp. So it was with this excellent and worthy man : 
fortune was favouring him in all and every way. In this 
spot he was seized with malignant bilious fever, and died 
on t the fifth day after the attack. I was not present 
during the sickness of this gentleman, but I was informed 
by the medical attendant, that the brain was never af- 
fected, and that such was the insidious nature of the 
disease, the patient was the first who became sensible of 
the danger; and when all hope had fled, his dying 
moments, calm and resigned in the extreme, were truly 
enviable. It is related somewhere, that Varro advised the 
proprietor of an unhealthy farm to quit or sell it ; at 



BILIOUS REMITTENT FEVER. 



181 



any rate, if he did not, he deserved to be confined as a 
madman. 

As the parish of Portland extends from the sea-shore to 
the highest mountains, it might be inferred that we should 
have all the climates which the island can afford ; the 
greatest heat being experienced in the lowest situations, 
and the least being found on those lofty pinnacles which 
seem to tower into the very heavens. 

So far, indeed, as regards heat, the inference would be 
correct, but there are other climates, at least one other 
climate, which would be sought in vain in Portland, 
that is, a dry climate. From its mountains and jungles, 
covered with eternal forests, Portland cannot be other- 
wise than humid, although, in the recollection of many 
inhabitants, it has considerably improved, even in this 
particular. 

The sea-shore and its vicinity are certainly the most 
unhealthy districts, being often a succession of morasses, 
some cultivated, and some in a state of nature; rank, 
moist, and rotten, they are all more or less pestilential at 
times, especially in droughts, when their horrid effluvia, 
undiluted by rain, and concentrated by the sun's heat 
and the evaporation of the sea-breeze, poison the atmo- 
sphere, and communicate diseases of the most malignant 
character. 

The interior and upper regions are infinitely healthier 
and pleasanter, an elevation of a few hundred feet making 
a very sensible, and no less agreeable difference, in the 
heat and quality of the air; and an individual is compa- 
ratively secure from the effects of malaria. 

Dry weather, however, does not improve the salubrity 
of the air, after the month of March, in this quarter ; on 
the contrary, showery weather is the most healthy, and 



182 



BILIOUS EEMITTENT FEVER. 



even the wettest seasons seem to affect the constitutions 
of all the inhabitants more than drought does * 

In a picturesque point of view, no country on earth 
can surpass this little parish : rock, wood, and water, the 
finest cultivation, and the most bewildered solitudes, smil- 
ing valleys, and mountains really awful, present them- 
selves in one grand, variegated, and yet harmonious mass. 
The high peak of the Blue Mountains rises eight thousand 
feet above the sea ; its outline no less elegant than conspi- 
cuous ; and though cut by nature into ridges, precipices, 
immense hollows, and ravines, this mighty chaos is yet 
crowned with everlasting verdure, and is a forest nearly 
to its summit. 

If there be any deficiency in the component parts of the 
landscape, it is in the article of water — so far as the eye 
desires it, at least. The gigantic proportions of the moun- 
tains, and even minor hills, take away all dignity from 
most of the rivers, not one of which is at all navigable, in 
spite of the deluges of water which they discharge at 
times. 

The size and luxuriance also of the foliage screen a 
great many of the rivulets from observation, and, in not a 
few instances, the temporary rivulets themselves sink down 
into the earth and disappear through chinks, and some- 
times through capacious holes, as at Kemnay and other 
places in the mountain land of the parish. These streams 
appear again on the sea-shore, and it is by no means an 
uncommon sight to see a stream of excellent fresh water 
starting from amidst the sandy beach, washed by the 
water of the Atlantic, as at Fairfield, White Hall, and 
other places. A very few of them are impregnated with 

* It is exactly the reverse as regards the city of Kingston, 



BILIOUS REMITTENT FEVER. 



183 



salt, which they must have imbibed in their subterranean 
course. The disappearance of these waters may account, 
in some measure, for the character of the dingles and cock- 
pits of the country, many of which resemble craters or 
funnels, though there is no appearance of anything vol- 
canic in this quarter. 

The soil is generally vegetable mould mixed with some 
clay, reposing upon porous lime or chalk-stone, the first 
interspersed with fissures, the latter soft and more com- 
pact, and fit for building, at but little cost in shaping it. 
The limestone along the coast, or honeycomb rock as it 
is called, is very hard and sharp, and no less perilous to 
walk upon than broken bottles would be. 

There are many veins of excellent marble, and some of 
coal, neither of which are sought after or appreciated. 

In the environs of the town there is an extraordinary 
cave of great magnitude. It is for the most part dark, 
except at the entrance. After getting into a fissure or 
doorway, you descend by steps into a long vestibule 
formed by incrustations or petrifactions, exceedingly cu- 
rious. The soil, or rather covering to the floor of this 
apartment, imparts to the person the sensation as if he 
w r ere walking on a Turkey carpet ; it is a congeries of 
bats' dung, seven or eight feet deep, the deposit of some 
hundred years. Leaving this apartment, lights are re- 
quired to guide you through the various rooms, anterooms, 
and closets. Pillars, columns, fonts, and couches, obtrude 
upon the sight, turn which way you will. The light re- 
flecting upon the stalactic sparry matter forms a brilliant 
contrast to the gloom at the entrance : here and there you 
may meet with a column in the process of forming, by a 
constant dripping of the coldest water from the ceiling, 
which is full of holes and cones, the former serving as 



184 



BILIOUS REMITTENT FEVER. 



asylums for the innumerable quantity of bats, whose medi- 
tations are disturbed by the sound of human voices, and 
the light emitted from the torches necessary for one's 
safety in exploring this phenomenon of nature. Very few 
strangers visit Portland without paying a visit to this cave, 
and I believe are very well repaid for the trouble and 
fatigue they take, in climbing up the rocks to take a peep. 
The entrance may be about one hundred feet above the 
level of the sea. 

The water throughout the parish is excellent, and for 
lightness and purity is not surpassed in any portion of the 
globe. 

There are several petrifying springs, the principal of 
which is on the west bank of the Rio Grande, about four 
miles from the coast, where it empties itself. 

Nearly the whole parish appears to be unfavourable 
for the growth of Guinea grass. The land in general is 
but ill adapted for pastures, and the cattle suffer in conse- 
quence. After the grass has seeded in the month of 
October, it loses all its nutritious qualities, and, if not taken 
care of, would rot and die. 

Unfavourable, however, as is this parish in this parti- 
cular, it cannot be surpassed in its farinaceous ground 
provision, which, to the peasantry, not only supplies all 
their wants, but yields them a very profitable return for 
their labour. The negroes carry on considerable traffic 
with all parts of the country, getting in exchange for their 
yams, cocoas, and plantains, money and whatever other 
articles they may require. The rivers (the Grande in 
particular) are well stored with delicious fish, of great 
variety. 

The back highwood lands furnish several species of 
game : the ringtail pigeon is a fit morsel for epicures. Wild 



BILIOUS REMITTENT FEVER. 



185 



hogs are frequently hunted and taken by the Maroons, 
who prepare the meat in a peculiar way by smoking it in 
flitches ; they carry it to the market, and sell it at one 
shilling and threepence per pound : it is esteemed a great 
delicacy. 

The harbours, bays, and creeks, compensate the fisher- 
men for their trouble and risk. Although the market is 
not regularly supplied, a great quantity of excellent fish 
is brought into the town. 

The medical botanist will find a great many valuable 
plants without much trouble, by taking a negro guide 
into the woods ; and at a trifling cost he will impart his 
instinctive knowledge most cheerfully. I have often been 
surprised at their quickness in finding the plant sought 
for. 

Nature has been very bountiful in her gifts to Portland, 
in common with other parishes in Jamaica, by furnishing 
timbers well adapted for the various purposes of building, 
furniture, millwright, and dyeing; they may be found in the 
woodlands of almost every estate in the parish, but the 
districts in which they abound the most, in Kemnay, 
Cambridge, Darly. 

There seem to have been no troops at this station in 
1825 and 1826, but the mortality during the other years 
embraced in this report, has been as follows : — 



186 



BILIOUS REMITTENT FEVER. 









Ratio of deaths 


Years, 


Strengh. 


Deaths. 


per 1000 of 








mean strength. 


1817 


177 


34 


192 


1818 


135 


12 


89 


1819 


130 


45 


346 


1820 


143 


12 


84 


1821 


82 


18 


219 


1822 


194 


10 


52 


1823 


79 


4 


51 


1824 


108 


21 


194 


1827 


32 


3 


94 


1828 


129 


19 


147 


1829 


133 


31 


233 


1830 


155 




loo 


1831 


161 


20 


124 


1832 


157 


29 


185 


1833 


164 


37 


226 


1834 


185 


32 


173 


1835 


154 


18 


117 


1836 


160 


4 


25 


Total 


2478 


370 




Average 


137 


20 


149-3 



With the exception of last year, the mortality at this 
station has been uniformly very high, amounting, on the 
average of the whole period, to 149 per thousand of the 
strength annually, being considerably above the usual 
ratio throughout the island. 



FALMOUTH. 

This town is situated at the root of a peninsula stretching 
into a bay which forms the harbour of Falmouth. From its 
position it is well exposed to the breeze, but on every side 
except towards the sea is surrounded by a marsh communi- 



1'age 186 




BILIOUS REMITTENT FEVER. 



187 



eating with the ocean, and frequently covered at high water ; 
on the reflux of the tide, there is generally accumulated a 
large quantity of mud, leaves, and other vegetable matter, 
producing most offensive effluvia during the land-wind. 
Though the soil is sandy, with a rocky substratum, yet, 
from the low situation of the town, it is impossible for 
the water in many places to drain off, so that after heavy 
rains pools are formed which remain till evaporated. 
About half a mile from the town, on the south, a sluggish 
river empties itself into the sea ; its banks are low and 
muddy, and generally overflowed during heavy rains. 
The nearest hills are about three miles to the south, from 
which they stretch towards the sea in a westerly direction, 
at the distance of eight miles ; the intervening country is 
a complete marsh communicating with the sea, and 
covered with low trees and brushwood ; the air of the 
station is consequently damp, the soil wet, and decayed 
vegetable matter abundant. The well-water is so bad 
that the supply for the use of the troops and inhabitants 
has to be brought from the river. 

The barrack and hospital are situated at the extremity 
of the town, on a limestone rock projecting into the sea, 
where there is generally a cool breeze. The barrack con- 
sists of a stone building of two stories, with a gallery and 
piazza facing the sea to the north ; the band and staff 
sergeants occupy a separate building also of two stories, 
the whole enclosed by a high wall separating it from the 
town in the rear, where the officers and married men are 
quartered in hired lodgings. The hospital is a stone 
building, raised on arches, and consists of two stories of 
one ward each, with galleries in front and outhouses 
in rear. 



188 



BILIOUS REMITTENT FEVER. 



Notwithstanding the apparently unfavourable nature of 
the locality, the mortality at this station has been under 
the general average of the island, as will appear from the 
following table : — 









Ratio of deaths 


Years. 


Strength. 


Deaths. 


per 1000 of 








mean strength. 


1817 


121 


9 


74 


1818 


134 


9 


67 


loin 

loiy 


123 


16 


130 


1820 


120 


23 


192 


1 QOl 


ilo 


6 


53 


1322 


223 


26 


117 


1823 


165 




91 


1824 


192 


10 


52 


1825 


174 


32 


184 


1826 


119 


27 


227 


1827 


176 


41 


233 


1828 


165 


10 


61 


1829 


178 


9 


51 


1830 


245 


21 


86 


1831 


208 


53 


255 


1832 


212 


16 


75 


1833 


372 


26 


70 


1834 


294 


28 


95 


1835 


263 


22 


84 


1836 


291 


11 


38 


Total 


3,888 


399 




Average 


194 


20 


102-6 



Thus on the average of the above period the mortality 
has amounted to about 103 per thousand of the force 
annually, being 19 per thousand under the mean mortality 
of the island. 



f 



i 



BILIOUS REMITTENT FEVER. 



189 



MONTEGO BAY. 

The town of this name lies about 15 miles west of 
Falmouth, at the foot of a range of mountains surrounding 
it on every side except the north-west, where they open 
to the sea, and form the bay at the extremity of which the 
town is built. The sea-breeze being much obstructed by 
these mountains, the heat is more intense than in any 
other part of the island, and the town and its vicinity 
have always borne an extremely unhealthy character. 

The barrack and hospital are situated at the south- 
eastern extremity of the town, and are built of stone, but 
without galleries ; they have not been occupied during 
nine of the years included in this report, owing to their 
extreme unhealthiness, but during the other eleven years 
the mortality of the troops quartered in them has been 
as under : — 









Ratio of deaths 


Years. 


Strength. 


Deaths. 


per 1000 of 








mean strength. 


1817 


90 


8 


89 


1818 


23 


2 


87 


1822 


39 


2 


51 


1824 


23 


5. 


217 


1828 


66 


14 


212 


1829 


46 


5 


109 


1832 


123 


44 


358 


1833 


144 


25 


174 


1834 


132 


16 


121 


1835 


111 


6 


54 


1836 


92 


32 


348 


Total 


889 


159 




Average 


81 


14 


178-9 



190 



BILIOUS REMITTENT FEVER. 



This station has uniformly proved very fatal to the 
troops. Even so far back as 1794 it bore the same cha- 
racter, for the deaths during the four previous years 
amounted to from 11 to 12 per cent., while other stations 
were comparatively healthy, and it was then estimated to 
be the most insalubrious spot on the island. Independent 
of the deaths which are recorded in the preceding table, 
a great proportion of the mortality, by fever, at Maroon 
Town originated here, as will be explained in the details 
of that station. 



MAROON TOWN. 



This post is situated on a high range called the Tre- 
lawney Mountains, in the interior of the island, upwards of 
2000 feet above the level of the sea, and lies about twenty 
miles south of Falmouth, and eighteen west of Monte go 
Bay. It is surrounded on all sides but one by still loftier 
mountains, clothed to the summit with stately trees ex- 
hibiting every variety of foliage. The view is open to 
the north-east, and exhibits a vast expanse of sea and 
land scenery. The whole extent of ground occupied by 
the garrison is about 200 acres, much interspersed with 
small hillocks and valleys. These eminences have been 
chosen for the site of the houses and barracks erected for 
the accommodation of the troops, which, owing to this 
circumstance, are considerably detached from each other. 



BILIOUS REMITTENT FEVER. 



191 



The principal building occupied as a barrack is of two 
stories with three large rooms in each, and an open 
verandah on the north. The married soldiers live in small 
huts built by themselves, bordering on the parade-ground. 
The hospital is about half a mile from the barrack on a 
small eminence, and consists of two buildings of two 
stories each, connected together on the upper floor by a 
wooden gallery, the lower floors occupied by the surgeon 
and hospital sergeant, the upper ones by the patients. 
The surrounding hills abound with springs of excellent 
water, and this post is said to possess every advantage 
which can conduce to health, or render residence in a 
tropical country desirable. 

Being surrounded by high mountains, the climate is 
variable, and the temperature liable to sudden transitions. 
There is much rain, and the evaporation subsequently 
caused by a tropical sun produces frequent and dense 
fogs. The thermometer seldom rises higher than 80°, and 
sometimes at night and towards dawn it is, in winter, as 
low as 52°. The soil is a deep red clayey loam, extremely 
tenacious, rendering it almost impracticable to walk out 
for some hours after a shower, and retaining moisture for a 
very considerable time, being, in this respect, like the soil 
in the neighbourhood of Spanish Town, though fortunately 
the mortality is on a very different scale, as will be seen 
from the following table : — 



192 



BILIOUS REMITTENT FEVER. 









Ratio of deaths 


Years. 


Strength. 


Deaths. 


per 1,000 of 






mean strength. 


1817 


99 


None 


None 


1818 


101 


] 


10 


1819 


82 


1 


12 


1820 


68 


2 


29 


1821 


77 


2 


26 


1822 


198 


Q 


30 


1823 


259 


g 


35 


1824 


237 


9 


38 


1825 


198 


Q 


30 


1 826 


241 


5 


21 


1827 


234 


7 


30 


1828 


172 


7 


41 


1829 


194 


3 


15 


1830 


240 


14 


58 


1831 


271 


13 


48 


1832 




11 


0/ 


1833 


185 


15 


81 


1834 


247 • 


4 


16 


1835 


250 




4 


1836 


280 


8 


29 


Total 


3,797 


124 




Average 


190 


6 


32-7 



By this table it appears that there are some localities 
where the loss of life does not greatly exceed that of more 
temperate climates. The mortality on the long average 
of twenty years has amounted to only a fourth part of 
what generally prevails throughout the island, and a large 
proportion even of that has originated from disease not 
contracted at this station. During several years in which 
troops were not permanently quartered at Montego Bay, 
it was customary to send detachments there from Maroon 
Town during the negro holidays, and these always brought 
back a large proportion of sick, and many fatal cases. 
The detachments at Falmouth and Lucea too, when sickly, 
have occasionally been relieved by healthier ones from 
this post, and it has sometimes happened that the corps 




rage 192 



Jhge 293 




BILIOUS REMITTENT FEVER. 



193 



sent to Maroon Town had previously been suffering under 
a great mortality in other parts of the island, and brought 
with them many sick in a dying state. After a diligent 
investigation, it appears that from thirty to forty of the 
deaths included in the above table may fairly be attri- 
buted to one or other of these causes, so that the actual 
mortality of the station has not exceeded 22 per thousand 
of the force annually, being the same as among the Foot 
Guards in London on the average of the last seven years. 

Nor has this remarkable salubrity been confined to the 
period embraced in this report, but ever since British 
troops were quartered at Maroon Town it has borne the 
same high character ; as an instance of which we may 
mention, that from the 1st September 1795 to 30th April 
1797, when about 220 of the 83rd Foot were quartered 
there, they lost only twelve men, six of whom were 
brought from Montego Bay in bad health; so that the 
actual mortality of the station during these two years 
could not have exceeded one and a half per cent., being 
under the usual average among troops in the United 
Kingdom. 



LUCEA. 

The town of Lucea lies about fifteen miles west of 
Montego Bay, at the extremity of a spacious bay, and en- 
circled by the mountains of Hanover and Westmoreland, 
which rise to a great height immediately behind it. The 
ground in the vicinity presents a hilly and undulating 
appearance, is in a high state of cultivation, and there are 
no jungles or marshes in the neighbourhood. The troops 
are stationed in Fort Charlotte, which is situated on the 

o 



194 



BILIOUS REMITTENT FEVER. 



north-east extremity of a peninsula, bounded on one side 
by the bay and harbour of Lucea, and on the other by the 
sea. The barrack and hospitals are built on pillars, which 
form a piazza, and admit a free circulation of air beneath, 
an object of great importance in such a climate. The 
barrack is a new building, erected in 1834. 

The climate of Lucea is cool and pleasant in comparison 
with the other stations along the coast, except during the 
months of July, August, and September, when the tem- 
perature is considerable, the thermometer sometimes ris- 
ing as high as 85°. There is always a refreshing sea-breeze 
during the day, and a cold land-wind from the adjacent 
mountains generally prevails during the night. 

There seem to have been no troops stationed here in 
1831, but the mortality during the other years embraced in 
this Report has been as under : — 









Ratio of deaths 


Years. 


Strength. 


Deaths. 


per 1000 of 








mean strength. 


1817 


70 


5 


71 


1818 


63 


6 


95 


1819 


63 


5 


79 


1820 


67 


3 


45 


1821 


73 


3 


41 


1822 


92 


7 


76 


1823 


92 


8 


87 


1824 


109 


7 


64 


1825 


90 


16 


178 


1826 


47 


2 


43 


1827 


99 


3 


30 


1828 


84 


1 


12 


1829 


86 


3 


35 


1830 


80 


28 


350 


1832 


96 


16 


167 


1833 


85 


3 


35 


1834 


76 


2 


26 


1835 


119 


3 


25 


1836 


75 


12 


160 


Total 


1566 


133 




Average 


83 


7 


84-9 



Fage 195 




BILIOUS REMITTENT FEVER. 



195 



Thus it appears that this station has enjoyed a con- 
siderable exemption from that mortality which has fallen 
so heavily on many of the others, the average deaths being 
84 per thousand of the strength annually, or 37 per 
thousand under the mean of the whole island. It has a 
high reputation for salubrity among the inhabitants, and 
is on that account often resorted to by convalescents. 

The distinguishing feature in the diseases of this station 
is, that the mortality by fever is little more than half the 
average throughout the island. The troops, in a great 
measure, escaped the epidemics of 1819, 1822, and 1827 ; 
but what is rather remarkable, they have suffered severely 
from fever in years when most parts of the island were 
exempt from it. In 1830, for instance, a comparatively 
healthy year elsewhere, a third part of the troops were 
cut off by fever alone ; and last year, which was healthy 
throughout the island, a ninth part of the force died from 
the same cause. 

Diseases of the lungs occasion more mortality than at 
any of the other stations. The other classes offer no marked 
peculiarity. 

Having illustrated thus particularly the mortality and 
fatal diseases at the permanent military stations of this 
island, we shall next give a brief detail of the deaths 
among the detachments at several small out-posts which 
have occasionally been occupied by our troops during a 
portion of the period embraced in this Report. The first 
of these is 

SAVANNAH-LA-MAR, 

a town built on the sea-beach at the south side of the 
island, and near its western extremity. The adjacent 

o 2 



196 



BILIOUS REMITTENT FEVER. 



country, to the distance of twelve miles, is a low, alluvial 
flat, richly cultivated, and bounded by a range of lofty 
mountains. Though level, the ground is not swampy, but 
the soil being of stiff clay mixed with gravel, and slightly 
covered with vegetable mould, does not readily absorb 
moisture. The temperature is moderate and equable, and 
there appears nothing in the position to render it so ex- 
ceeding fatal as it has proved to its garrison, among whom 
the deaths from L817 to 1822 were as follow: — 



Years. 



1817 
1818 
1819 
1820 
1821 
1822 

Total 



Strength. 



70 
58 
56 
45 
51 
31 



311 



Deaths. 



Ratio of deaths 
per 1000 of 
Strength. 

114 
103 
232 
155 
137 
677 



62 Average 200 



being a fifth part of the force annually. After the loss of 
two-thirds of the detachment in 1822, no troops were 
sent to this station till 1824, when a detachment of one 
hundred and seventeen arrived ; they remained only 
three months, during which they lost five. In the follow- 
ing year fifty-four arrived, of whom six died within as 
short a period. The station was then left unoccupied till 
1832, when, in consequence of the insurrection, twenty- 
four men were sent there, of whom three died in two 
months, besides several after their return to Maroon 
Town. On each of these occasions almost every indi- 
vidual in the detachment suffered from an attack of fever 
before he left the station. 



BILIOUS REMITTENT FEVER. 



197 



All the deaths were caused by fever, except one by con- 
sumption, three by diseases of the bowels, and four by 
diseases of the brain. The numbers are too few, and the 
period too limited, however, to attempt drawing from such 
data any specific deductions as to the relative prevalence 
of these diseases. 



PORT MARIA. 

This post is situated on the north side of the island, 
about thirty miles to the west of Port Antonio. Owing to 
its extreme insalubrity, it has not been occupied since 
1817, in which year, out of a detachment of fifty-eight 
men, twenty-four were cut off in nine months. It has 
always borne the same unhealthy character ; indeed, long 
experience has proved that a great part of the northern 
sea-coast of this island, particularly from this post to 
Manchioneal, is at all seasons extremely insalubrious, and 
can never be garrisoned by European troops without a 
great sacrifice of life. 



Owing to an insurrection of the negroes in the north 
and east of the island in the beginning of 183*2, a very 
considerable addition was made to the white troops sta- 
tioned there, and unfortunately it became necessary, for 
the protection of the inhabitants, to send out a number of 
small detachments, which were not withdrawn till last 
year. The following details of the sickness and mortality 
which prevailed among them, though by no means com- 



198 



BILIOUS REMITTENT FEVER. 



plete, will serve to illustrate the extreme insalubrity of 
many of the positions selected on this occasion, and may 
prevent their ever being re-occupied on a similar emer- 
gency. 

MANCHIONEAL, 

This post is situated on the sea-coast, at the north- 
eastern extremity of the island, about twenty miles from 
Port Antonio, but we are otherwise unacquainted with its 
topography. As we have stated above, it lies in a dis- 
trict notoriously unhealthy, an instance of which may be 
found in the fate of a detachment of twenty-two men sent 
there from Port Antonio in 1832, of whom nine died 
shortly after their arrival : every individual was attacked 
by fever, and at the period of their removal not a man of 
the detachment was fit for duty. 

BUFF'S BAY. 

This post lies on the north side of the island, about 
twenty miles to the west of Port Antonio. A detachment 
of twenty-five men were sent here from that station in 
1832, during the Christmas holidays. In the course of a 
month seven of them died, and the rest were withdrawn 
before the end of January, owing to the sickly state to 
which they were reduced. 

ST. ANN S BAY. 

This post lies in a very low situation on the north side 
of the island, about sixty miles to the west of Port An- 



BILIOUS REMITTENT FEVER. 199 

tonio, in a great measure excluded from the sea-breeze, 
and exposed to the influence of an extensive moras, about 
two miles to windward, which has always given it a very 
unhealthy character. A detachment of seventy men was 
sent here during a few months of 1833, but in that short 
period eleven were cut off by fever, and the rest were re- 
duced to so sickly a state, that it became necessary to re- 
move them to 

SANS SOUCI, 

about a mile from St. Ann's Bay, and situated on a hill 
four hundred feet above the level of the sea, having a fine 
free exposure. Here the detachment, now reduced to 
sixty men, enjoyed a tolerable degree of health, as will 
appear from the following return of the deaths during the 
last three years: — 



Years. 


Strength. 


Died. 


1834 


10 


4 


1835 


61 


3 


1836 


54 


5 


Total 


185 


12 



or sixty-five per thousand, being under the average mor- 
tality of the island during that period. 



BATH. 

This post is situated near the south-east extremity of 



200 



BILIOUS REMITTENT FEVER. 



the island, about seven miles from the sea, and forty-eight 
from Kingston, in a very low and damp country, sur- 
rounded by hills, and watered by numerous streams, 
which inundate the ground after heavy rains, and, till 
evaporated, leave it in a very marshy state. A detachment 
of sixty men was sent here about Christmas 1833, and in 
the returns of the following year we find seventeen deaths ; 
and in 1835, twenty deaths out of a force of eighty, being 
upwards of a fourth part of the original strength annually. 
With the view of improving the health of the detachment, 
it was removed to 

GREENCASTLE, 

seven miles distant, situated on the summit of a height, 
about one thousand feet above the level of the sea, and sur- 
rounded by a succession of hills, in a fine, open, pastoral 
country, free of bush or underwood. Till the month of 
July 1836, the expectation of this proving a healthy resi- 
dence appeared to be realised, but a most fatal fever then 
broke out, which in one month cutoiftwenty out ofeighty- 
four ; three-fourths of the detachment were attacked by it, 
and the survivors were left in so debilitated a state, that 
they had all to be withdrawn. 

CHAPELTON. 

This post is situated nearly in the centre of the island, 
on the extremity of a ridge, which projects into an irre- 
gular but extensive valley, surrounded by hills from fifteen 
hundred to two thousand feet in height : the soil is a 
clayey loam or limestone, and all well cultivated ; the 



BILIOUS REMITTENT FEVER. 



201 



temperature low, and atmosphere generally humid and 
foggy. A detachment of ninety-one men was sent there 
in July 1833, and quartered in a spacious court-house three 
or four hundred feet above the valley. Remittent fever 
appeared among them about a fortnight after their arrival ; 
of the whole number only one escaped being attacked 
by it, and before the month of December, when they were 
withdrawn, eleven had died at the station, and three im- 
mediately after their removal, making in all fourteen in six 
months ; the rest were so debilitated by their sufferings, 
that scarcely a man was able to march from his quarters. 

BIDDEFORD. 

This post is also in the interior of the island, in the 
parish of Trelawney,and eighteen miles from Falmouth. A 
detachment of sixty- three men was sent to it in July 1833 ; 
but remittent fever broke out in the middle of August, and 
before the end of October sixteen had died, and almost 
every one had been attacked by it : the survivors were im- 
mediately withdrawn in a very sickly and debilitated state, 
and several sauk under the disease within a short time 
after their removal. 

LACOVIA. 

This post lies in an open expanse of country, on the 
south side of the island, near the banks of the Black River, 
about twelve miles distant from the sea, and eighty-four 
from Kingston. A detachment of seventy-six men was sent 
here from Fort Augusta in 1834. Fever soon made its 
appearance among them, and raged with such violence 
that six died before they could be removed, four within a 



202 



BILIOUS REMITTENT FEVER. 



few hours after they embarked for Fort Augusta, and fifteen 
within a day or two after their arrival, making in all 
twenty-five: scarcely an individual escaped the disease, 
and the whole detachment remained for a long time in a 
very debilitated and sickly state. 



UNITY ESTATE. 

This lies in the parish of St. Mary's, on the north side 
of the island, in the neighbourhood of Port Maria, before 
described as a very unhealthy tract of country. A de- 
tachment of seventy men was sent here in July or August 
1834 ; but in the course of one month after their arrival, 
twelve died, and the remainder were immediately with- 
drawn ; several died after their removal, whose deaths we 
are unable to trace. 



Taking the average of all these posts, it may safely be 
computed that the whole of the troops employed in gar- 
risoning them would at this rate have been cut off in less 
than two years ; and all this mortality occurred at a period 
when the island enjoyed more than a usual degree of 
salubrity : what then must it have been in an unhealthy 
year ? It is fortunate that the necessity for retaining 
such posts no longer exists ; and that, should it ever again 
be requisite to detach troops throughout the island, the 
dear-bought experience of these years can now be made 
available for procuring more healthy localities. That 
such are to be found in this island, we have already 
shown by the instance of Maroon Town, and we have 



BILIOUS REMITTENT FEVER. 



203 



now several additional proofs in the low rate of mortality 
experienced at the following stations : — 

PHGENIX PARK. 

Situated on a mountain about 2000 feet above the level 
of the sea, and enjoying a cool temperature, with a climate 
much the same as Maroon Town. A detachment was 
quartered here for three years and a half, of which the 
returns furnish the following details : — 



Years. 


Strength. 


Deaths. 


1833 


\°40 




1834 


72 


5 


1835 


66 


1 


1836 


69 


1 


Total 


247 


7 



being at the rate of only 29 per thousand annually, or less 
than a tenth part of the mortality experienced by some of 
the other detachments. 

MONTPELIER. 

Situated on the summit of a hill in the interior, but of 
what elevation we are not aware. As its name imports, it 
enjoys a high character for salubrity, which has been well 
supported by the healthy state of a detachment quartered 
there for four years, among whom the mortality was as 
follows : — 



204 



BILIOUS REMITTENT FEVER. 



Years. 


Strength. 


Deaths. 


1833 


60 


1 


1834 


61 


2 


1835 


80 


4 


1836 


67 


1 


Total 


268 


8 



or 30 per thousand annually. 

MANDEVILLE. 

Of the situation of this post we can furnish no details ; 
but, from the low rate of mortality, it is supposed to be 
in some of those high mountain ranges which experience 
has proved so salubrious ; a detachment was stationed 
here for three years, in which the mortality was as 
follows: — 



Years. 


Strength. 


Deaths. 


1833 


78 


1 


J 834 


75 


1 


1835 


74 


6 


Total 


227 


8 



being 35 per thousand annually. 

Here, then, we have an instance of three detachments, 
which, in these healthy stations, have altogether suffered 
less from mortality in the space of four years, than some 
of the detachments at the others in the course of as many 



BILIOUS REMITTENT FEVER. 



205 



months, and indeed enjoyed as great a degree of health 
as it seems possible for European troops to do within the 
tropics. We have another, though not quite so striking 
an instance of this in the post of 

CALEDONIA. 

Situated at the western extremity of the island, on the 
side of a rocky hill, surrounded by others, which tower to 
the height of nearly six thousand feet, and are covered 
with small trees and brushwood. Here the thermometer 
at night frequently falls as low as 60°, but ranges from 
80° to 88°, during the hottest period of the day. The 
rains are almost incessant from March to October, and 
the atmosphere humid, and subject to thick fogs. 

The detachment at this post enjoyed very goodhealth dur- 
ing two years ; the third was rather unhealthy, owing to the 
prevalence of fever of the common continued type, which 
proved fatal to about a seventh part of the number. Even 
including these, however, the mortality did not nearly 
amount to the usual average of the island, as will be seen 
from the following details : — 



Years. 


Strength. 


Deaths. 


1834 


80 


4 


1835 


85 


1 


1836 


77 


11 


Total 


242 


16 



being at the rate of sixty-six per thousand of strength 
annually. 

It is to be regretted that we do not possess a more 



206 



BILIOUS REMITTENT FEVER. 



minute description of the localities which have operated 
so favourably to our troops, as well as of those which have 
had the' reverse effect in so very remarkable a degree, 
seeing that it might have proved of such material service 
in regulating the selection of detached posts in future. 
We can therefore merely solicit the attention of the au- 
thorities to the numerical details we have exhibited, as a 
sufficient proof that, with well-chosen positions for our 
troops, service in this climate need not necessarily induce 
that expenditure of life, and deterioration of constitution, 
which has hitherto attended it. 



GENERAL SUMMARY. 

Before framing a summary of our conclusions in regard 
to the salubrity of each station, it may be necessary to test 
their accuracy, by ascertaining whether the aggregate 
strength and deaths at all of them, collectively, correspond 
with these data, as stated in the general tables at the com- 
mencement of this Report. 

In Table 35 the aggregate 
strength of the white troops 
serving throughout the island 

was stated at . . 51,567, the deaths at 6,254 

In Table 37 the aggregate 
strength of the black troops 
and pioneers serving there 

was stated at . . 5,729, the deaths at 172 



Total 57,296 6,426 



BILIOUS REMITTENT FEVER. 



207 



In the preceding division of the mortality, according to 
the stations where it occurred, we stated the aggregate 
strength and deaths at each to have been as under : — 



Stations. 


Strength. 


Total 


Stations. 


Aggregate 
Strength. 


Total 
Deaths. 


Up-Park Camp . 


14,520 


2,042 
573 


Green Castle 


84 


20 


Port Royal . 


5,068 
7,786 


Chapelton 


91 


14 


Fort Augusta 


572 


Biddeford 


63 


16 


Spanish Town 


6,719 


1,091 


Lacovia 


76 


25 


Stoney Hill . 


7,243 


653 


Unity Estate 


70 


12 


Port Antonio 


2,478 


370 


Phoenix Park 


247 


7 


Falmouth 


3,888 


399 


Montpelier . 


268 


8 


Montego Bay 


889 


159 


Mandeville . 


227 


8 


Maroon Town 


3,797 


124 


Caledonia . . . 


242 


16 


Lucea . . . 


1,566 


133 


At Kingston in \ 






Savannah-la-Mar 


506 


76 


1825, not included V 


150 


56 


Port Maria . 


58 


24 


with Fort Augusta, j 






Manchioneal 


22 


9 












Buff's Bay . 
St. Ann's Bay 


25 


7 


Total 


56,478 


6,474 


70 


11 


Total as above 


57,296 


6,426 


Sans Souci , 


185 


12 












Bath . 


140 


37 


Difference 


818 


48 



So that, over the whole period of twenty years, there is 
only a difference of forty-eight in the deaths, and eight 
hundred and eighteen in the aggregate strength, which is 
certainly as near an approximation as could possibly be 
expected in a force so much distributed. This difference 
is by no means likely to affect the accuracy of the results, 
as it would not average more than forty in the strength and 
about two in the deaths annually. 



208 



PECULIARITIES OF THE WEATHER 



PREVAILING DISEASES, 



1815. There was nothing unusual to interest the medical 
inquirer, that is, as far as this district was concerned. 
The weather is generally cool, and, for a West India 
climate, very healthy, particularly on the north side of 
Jamaica. Upon reference to the meteorological tables, it 
will be seen that there was a fair proportion of rain ; as 
much so as could be desired for the purposes of agricul- 
ture, as well as contributing to cool the atmosphere. The 
mercury in the shade was frequently as low as 68°. 

The prevailing winds from the north and north-east. 

April and May were fair, until towards the end it became 
variable, and a greater proportion of rain fell. 

June was ushered in by a deluge of rain, which appeared 
to be general in all parts of the island. The temperature 
of the atmosphere increased about three degrees. 

July was fair, but more sultry ; the temperature more- 
unequal, and the mercury seldom below 75°, and yet never 
above 84° in the shade. 

The first observation relative to the register kept of the 



BILIOUS REMITTENT FEVER. 



209 



maximum and minimum altitude of the mercury, is made 
every day about one hour before the sun has had any 
influence on the earth. 

August was much the same as July. On the 31st, the 
mercury suddenly fell, at three o'clock in the afternoon, 
from 88° to 82°. This phenomenon was preceded by a 
heavy fall of rain. 

September was dry, sultry, and the want of the usual 
trade wind made the climate at this period exceedingly 
oppressive to European constitutions. The mercury 
ranged between 76° and 88°. 

From the 1st to the 15th October, the weather was 
much the same as in the months of August and September. 
Light variable winds during the day, and nearly a total 
absence of the generally refreshing cool land-wind at 
night. On the 16th, the clouds hung low, and before 
noon a tremendous rain set in, which continued without 
intermission all day and night. On the 17th and 18th, 
the island was visited by one of those awful storms, pecu- 
liar to those months, denominated hurricane months. The 
county of Surrey suffered materially, particularly the 
parishes of St. George, St. David, the upper part of Port 
Royal, and Portland. The war of elements waged strong 
and fierce. Earthquake, lightning, hail, rain, the sea, 
uplifted into mountains, beat upon the iron-girt shore with 
tremendous and overwhelming violence ; the wind, at the 
acme of its power, roared with deafening noise ; the loudest 
human voice could not be heard, nor could any assistance 
be given to two vessels which were stranded in the port 
close to the beach, and within two hundred yards from 
the residence of several inhabitants, who were unconscious 
of the melancholy accident until the seamen were washed 
on shore ; fortunately no lives lost ; one of these vessels, the 

p 



210 



BILIOUS REMITTENT FEVER. 



Fox, was ready for sea ; the other, the Abraham Newland, 
arrived on the 16th : they were moored in the Eastern 
Harbour, which is supposed to be unequalled in Jamaica 
for security. This awful storm was by no means partial 
in its desolating effects ; the works of many sugar estates 
and coffee plantations were totally destroyed ; houses buried 
by avalanches of soil ; the rivers swollen to a fearful mag- 
nitude, rushing with the impetuous fury of cataracts, 
sweeping all before the irresistible body of water into one 
mighty chaos. The loss of human life by shipwreck was 
immense. 

From the afternoon of the 17th until noon of the 21st, 
the mercury remained stationary at 75°. 

The month of November was unsettled, squally, and very 
rainy ; the temperature of the atmosphere was moderate. 

There was a great fall of rain in December. Strong 
northerly winds prevailed for the most part of the month. 

The prevailing diseases during the first quarter con- 
sisted of a mild species of catarrh, pleurisies, and tertian 
fever. Dysentery was frequently met with, but this dis- 
ease confined its attack to the black peasantry ; it was 
not epidemic, and by no means fatal. In April, the pul- 
monic complaints were milder, and the intermittents had 
nearly disappeared, nor was there any further augmenta- 
tion to the list of diseases during the whole of May. 

A highly malignant form of bilious remittent fever ap- 
peared in the month of June. The first cases witnessed 
were on board a merchant ship in the Eastern Harbour ; 
the crews of two other ships sickened at the same time. 
There were several cases which were characterised by 
early gastric symptoms and black vomit, several of which 
terminated fatally about the third day. * 
* See note A, p. 249, 



BILIOUS REMITTENT FEVER. 



21-1 



There were frequent occurrences of this form of fever. 
In July? almost every ship in port furnished one or two 
cases. The inhabitants became very sickly, who suffered 
in proportion, and such as could, availed themselves of a 
retreat into the more cultivated and cooler parts of the 
parish. As this fever did not confine its ravages to any 
particular spot, but might be seen throughout the island, 
there was no longer any doubt as to the extent of the 
epidemic, which continued, with various degrees of severity, 
during the months of August, September, and part of the 
month of October. There was no distinction observed as 
to colour. The unacclimated whites suffered in the greatest 
proportion, and the mixed races the next. The blacks 
were very sickly, and a great number died ; but in this 
latter class of patients there was no instance of the black 
vomit.* 

A very fatal and severe epidemic, contagious hooping- 
cough, made its appearance in this parish (district) about 
the end of July, and continued with unrelenting fury during 
August, September, and part of October ; it was not less fatal 
in the mountainous parts of the parish ; it was almost im- 
possible to tell where the virulence of this disease was the 
greatest. It carried off a great number of children of all 
classes. 

The latter part of October, the months of November 
and December, were exempt from disease of any conse- 
quence. 

Intermittents and quotidians, and a few cases of cholera, 
were treated, which were neither numerous nor obstinate. 

It appears, therefore, from the foregoing remarks, that 
the tempestuous weather which set in on the 17th Octo- 
ber had a powerful influence in cleansing the air of im- 

* See note B, p. 250. 

p 2 



212 



BILIOUS REMITTENT FEVER. 



purities, changing the temperature of the atmosphere, and 
materially altering the type and character of the prevailing 
diseases. 

After the hurricane, there was scarcely a case of remit- 
tent fever in the parish ; and it is no less remarkable that 
the epidemic hooping-cough disappeared as suddenly. It 
is probable, however, that this disease had nearly ex- 
pended its virulence before the storm. But this remark 
will not hold good with respect to the epidemic bilious 
remittent fever; it was unquestionably owing to other 
causes, which I shall presently attempt to explain. 

This parish, as well as other parts of the island, is much 
more exempt from disease in wet than in dry seasons ; and, 
as will be seen in the tabular scale of the weather, a great 
quantity of rain fell in November and December, and but 
very little previous to the storm. The sudden salubrity of 
the district may be in part owing to this, and in part to 
the sudden change in the temperature of the atmosphere. 
Nothing can better illustrate the fact of the connexion 
of diseases with the changes of the atmosphere. I 
am, however, induced to believe that these changes do 
not for the most part affect individuals in health, except 
under certain circumstances, but that they operate power- 
fully on those in a state of disease, on the disease itself, 
and influence its diurnal appearance. 

This influence over disease may be supposed in part to 
arise from a change of temperature, and in part from a 
change taking place in the component parts of the air. 
To speak primarily, of a change of temperature. 

Sudden changes of temperature, I am of opinion, may 
produce an alteration in the character of the disease. 

The first effect of increase of temperature on the animal 
economy is evidently stimulant, and so, by a parity of 



BILIOUS REMITTENT FEVEE. 



213 



reasoning, diminished temperature will have an opposite 
effect, viz. a sedative influence. 

It is true these causes may have but a trifling power, 
unless the change be very considerable, over an individual 
in health, but on those labouring under disease trifling 
causes often produce alarming effects. By experience I 
have found that patients of strong and robust constitutions 
suffer but little from these causes, yet the nervous and 
irritable are severely influenced by them. 

Diseases, by these changes, from moderate may be 
changed and aggravated to the inflammatory type, or may 
run into the nervous and typhoid character. 

Diseases by these changes may also become so changed 
in type as really and truly to put on the appearance of 
different diseases, particularly when the changes are from 
a depressing sultry atmosphere to one some twelve or 
fourteen degrees cooler. This of course is to be under- 
stood as salutary, and amongst patients of irritable tem- 
peraments and broken constitutions, these causes, as I 
have before observed, produce considerable alterations : of 
such, perhaps in the morning I have congratulated myself 
with a favourable prognostic ; yet so widely have the 
symptoms differed in the evening, that my opinion has 
been completely reversed — hope has been turned to 
despair, and not unfrequently have I had to deplore the 
loss of a valuable life terminated by such untoward cir- 
cumstances. 

Here, however, as applies to the epidemics which were 
raging with so much deadly virulence during August, 
September, and part of the month of October, 1815, the 
effects were different, the invisible and subtle agent of 
disease was wafted from our shores as if by magic, and 
left the island comparatively healthy. 

In these climes, where we frequently witness patients 



214 



BILIOUS REMITTENT FEVER. 



struggle through days of acute disease, we naturally feel 
inspired with confidence, and our hopes are sanguine for 
his recovery ; yet even in such, when of the temperament 
before described, it is not an uncommon occurrence to see 
fevers operated upon by the changes, end fatally. 

If my mind has been influenced in a belief that sudden 
changes of temperature produce prejudicial effects in those 
labouring under disease, my conviction of the baneful 
effects of a change in the component parts of the air, either 
connected or unconnected with a change of temperature, is 
equally strong, particularly in the months of July, August, 
September, and October. 

It is remarked that, under any circumstances, during 
the sickly autumnal season, European constitutions are 
more liable to diseases of tropical climates, than at any 
other period of the year. It may be considered the time 
when the indigenous bilious remittent fever makes its 
appearance, with more or less malignancy; according, as 
I suppose, to the air being more or less charged with 
impurities, and more particularly in the plains and neigh- 
bourhood of swamps, and sometimes in the vicinity of an 
absorbent soil ; the tropical deluges of rain supplying the 
little rivulets, lakes, and swamps, with fresh materials 
Avashed from the neighbouring hills by the force of these 
torrents overflowing the plains below, there to be exposed 
to the powerful action of the sun, until the work of de- 
struction has commenced ; the land-wind at night wafts 
these unwholesome vapours into the dwellings of all 
within its influence, dealing havoc and devastation to young 
and old. 

From our knowledge that the red globules of the blood 
are oxydes, and from the similar appearance which the 
blood in a person labouring under typhus has with the 
returning venous blood in healthy subjects — the anxiety 



BILIOUS REMITTENT FEVER. 



215 



of respiration in these fevers may be accounted for, there 
can be little doubt, by supposing a deficiency of oxygen 
to be the cause of this symptom. 

This has been clearly proved by the learned traveller 
and chemist, Humboldt, who demonstrated that the atmo- 
spheric air, which does not possess a sufficient quantity of 
oxygen, or which is surcharged with azote, is hurtful to 
those who respire it, and that it is capable of engendering 
very malignant fevers. He demonstrated, also, that such 
is the state of the atmosphere in marshy countries, parti- 
cularly in autumn. In some earthy substances, he says 
he found a very active faculty of extracting and absorbing 
oxygen from the atmosphere. 

I cannot take upon myself to say whether these changes 
in the component parts of the air will produce a change 
in the temperature of the atmosphere ; but I have known 
a fluctuation of 12 or 14 degrees of the mercury to take 
place very suddenly in the autumnal season. 

As I before premised, during this season the tem- 
perature is very oppressive, often very unequal, and 
frequently without any breeze; these circumstances com- 
bined are quite enough to produce languor, and predispose 
the body to disease. Independent of these circumstances, 
the weight of the atmosphere is continually varying, from 
which we may infer that a continual change is going on 
in the component parts of the air, by which at one time, 
comparatively speaking, it may act as a stimulant ; at 
another as a sedative ; and hence arise those distressing 
symptoms which we cannot well describe, but which are 
owing, unquestionably, to a want of equilibrium in the 
animal economy, causing a derangement in the secretions, 
and probably conspiring to produce other diseases, — dis- 
eases which appear to be regulated by these changes, and 



216 



BILIOUS REMITTENT FEVER. 



none more conspicuously so than affections of the hepatic 
and biliary organs. 

If we assume 1,000 parts of atmospheric air, which, 
under ordinary circumstances, may be said to consist of 

Oxygen 210*0 

Azote 775-0 

Aqueous vapour . . . 14*2 

Carbonic acid . . . . 0*8 

1000 — 

we need be at no loss to conjecture what effects may be 
produced on the animal economy, were the component 
parts of this mixture so changed by foreign gases as to 
make it difficult to respire for any length of time. 



REMARKS ON THE PREVAILING DISEASES FOR THE 
YEAR 1816. 

The weather for the first three months of the year 1816 
was remarkably fine ; a more desirable climate could not 
be wished for. The temperature of the atmosphere was 
cool. The mean maximum of the mercury was 80°. 
There was not much rain— the prevailing winds from the 
east, east-north-east, with occasional strong northerly 
gales, which during this quarter of the year frequently 
occur. 

It was scarcely observed to rain during the whole month 
of April, either in the interior or along the whole line of 



BILIOUS REMITTENT FEVER. 



217 



coast. On the 28th heavy condensed clouds hung over 
the tops of the lofty Blue Mountains, and gradually 
descended into the lower ridges, where they emptied 
themselves of their aqueous contents. It continued to 
rain for the most part of the twenty-four hours of this day, 
as well as part of the 29th ; the 30th was fair. May and 
June were seasonable ; some heavy torrents of rain fell, 
but not extraordinary. July was very hot, very sultry, and 
very wet. The atmosphere was oppressive and unwhole- 
some. September and October were likewise truly dis- 
agreeable ; there was neither sea-breeze by day, nor land- 
wind at night. The absence of these refreshing visitants 
produces unspeakable lassitude in the European consti- 
tution. November was somewhat cooler, owing to the 
quantity of rain, with occasional squalls from the north- 
east. It rained almost every day in the month of December, 
— from the 7th to the 13th without intermission. I find, in 
my annual report of this year, the following remark : 

Not until the month of April did any sickness appear in 
the parish, arising from local or epidemical causes. A few 
cases of remittent fever were seen on board the merchant 
ships, but these were mild and easily controlled cases. 
The troops in the garrison, and the inhabitants both in 
the town and country, were remarkably healthy; and 
the peasantry suffered few or no ailments, excepting on a 
few properties on the confines of the parish of St. George, 
where the land is low and swampy. These ailments ap- 
peared in the form of intermittent fever, which sometimes 
terminated in diarrhoea. This complaint produced con- 
siderable debility ; several aged blacks died in conse- 
quence. May and June furnished but few cases of 
remittent fever of a mild form ; ophthalmia was prevalent. 

Some more acute cases of autumnal fever occurred in 



218 



BILIOUS REMITTENT FEVER. 



this month, in all about sixteen cases— Europeans and 
native whites; these fevers terminated in abscesses, par- 
ticularly in the axilla; — there was no fatal case. The 
remark in August specifies an addition to the fever cases, 
amounting in all to seven ;— the whole recovered. I 
observed that the country patients were less severely 
attacked than the residents of the town. In September 
five other Europeans were seized with fever, one of whom 
died on the 8th day. This case was a seafaring man, 
commanding a small coasting vessel, whose habits were 
irregular. Six cases of intermittent fever, of the tertian 
type, were attended. In October, the most acute case of 
bilious remittent fever, was the son of a highly-respected 
medical friend, a native of the country, thirty-two years of 
age. The history of this case was interesting ; he was 
attacked, whilst sitting at breakfast, with sudden giddiness, 
nausea, and palpitation. As I was nearly nine miles 
distant from his residence, I did not see him until about 
two o'clock in the afternoon. Pyrexia was then violent; 
intolerable headache, thirst, and restlessness, were the 
predominant symptoms. I bled him to 24 ounces; a 
blister was applied to the nape of the neck ; a mercurial 
cathartic, with saline effervescent draughts, administered 
every third hour. The paroxysm lasted until four in the 
morning ; the bowels then began to act, and a brisk 
catharsis was kept up for an hour or two. Before eight 
o'clock he was delirious ; he was again bled, the head 
shaved, and a cap-blister applied ; a powder, of five grains 
each of calomel and James's powder, was given every 
second hour ; barley-water ad libitum. This paroxysm 
was very severe : although he was unconscious of 
those around him, it was very evident that his sufferings 
were very acute, — he never refused his medicines or 



BILIOUS REMITTENT FEVEE. 



219 



liquids, water, or the water from the young cocoa-nut in 
particular. For the first time since the attack, per- 
spiration was observed on the hand and neck about two 
o'clock the following morning ; this I looked upon as a 
favourable sign, although at this moment he was still insen- 
sible ; the bowels were in active operation ; the secretions 
were highly bilious and vitiated. 

The pulse 120 ; heat of the trunk 104° ; — tongue foul. 
In the course of the morning sensibility returned, the per- 
spiration increased, and a totally different aspect pervaded 
the countenance. 

Before ten o'clock the pulse lowered to 100°. Acidu- 
lated decoction of bark, with infusion of snake-root, was 
duly administered every hour, and a fair intermission was 
established ; he had no return of pyrexia for eighteen 
hours. This paroxysm was not severe, nor did it last 
longer than about six hours. He eventually went into 
the mountain district, where he recovered his former 
health. 

The next case was not so fortunate. It was one too 
that I did not dread, owing to his length of residence 
in the island; and it was not the first attack of this 
formidable fever. He was by trade a carpenter, a 
remarkably hard-working, industrious fellow. There was 
nothing particularly different in this from the case above 
detailed, yet it is worthy of remark, that in severity the 
symptoms resembled those of the more robust patients. 
In this case delirium came on about the same period, but 
his sensibility did not return until a few hours before 
death. 

Several other cases appeared, but they had a favourable 
termination. There were eleven patients attacked with 
bilious remittent fever in November : one was a lady who 



220 



BILIOUS REMITTENT FEVER. 



had been many years in the country previous to her em- 
barking for Europe in August 1815. She returned in 
May of this year. I did not see this case until the 
seventh day after the attack ; she was the wife of a 
medical friend in the town. She died on the ninth day, 
with symptoms of great malignancy. Two seamen died. 
This was the list of mortality for November. The fol- 
lowing is a correct transcript from my diurnal register for 
December of this year. Treated during the month — old 
residents : — 



With remittent Fever 


. 15 


Newly arrived Europeans 


.7 


Intermittents (tertian and quotidians) 


5 


Ophthalmia ..... 


3 


Dysentery (blacks) 


. 13 


Acute hepatitis . . . . 


5 


Phrenitis, two adults, and one boy 


3 



In all fifty-one patients, of which died three cases of 
remittent fever, and one of the adults attacked with 
phrenitis, or coup de soleil, or whatever it may be deno- 
minated ; there were remaining also from the last month 
several cases of great debility. 

I cannot omit mentioning a few particulars of one of 
the fever cases which terminated fatally ; it was that of a 
young lady but recently arrived in the country. She 
successfully combated through the stages of fever with 
great resignation and fortitude, nor was the least danger 
apprehended until within a few hours of death, so very 
insidious was the approach to collapse, if it could be so 
called. She asked one of the female attendants for a glass 
of water, to which was added a small quantity of brandy ; 



BILIOUS REMITTENT FEVER. 221 

this she almost immediately rejected; the vomiting con- 
tinued for some minutes,, until she voided five large 
lumbrici. She had scarcely beheld these parasites one 
moment ere she became deeply agitated. Terrified in the 
extreme, she requested my immediate attendance. I lost 
no time in repairing to the spot. I can scarcely relate 
the anguish I endured when I beheld the prognostics of 
death on her pallid but beautiful countenance ; in a few 
hours the scene was closed. 

There was not the slightest suspicion during the seven 
days of her illness ; there was no symptom which indi- 
cated the presence of worms. 

I am inclined to suppose, but I may be wrong, that the 
shock upon the nervous system, already weak, occasioned 
by the sight of the worms she vomited, must have over- 
powered her too sensitive frame, and, being previously 
exhausted, she sank tremulously fearful into the arms of 
death. 



REMARKS ON THE PREVAILING DISEASES FOR THE 
YEAR 1817. 

For the first three months of the year 1817, no climate on 
earth could be more enticing than that of Jamaica ; a 
serene Italian sky, hardly a cloud to be seen, the Atlantic 
ocean girding the shore with its deep blue waters, the 
country exhibiting foliage of everlasting green, the tem- 
perature of the atmosphere equal to the south of France : 
if this scene could be prolonged, what country could be 
more desirable ? 



222 



BILIOUS REMITTENT FEVER. 



April, May, and June, although a little warmer, were 
nevertheless equally agreeable. 

The prevalence of southerly wind and rain, during the 
month of July, made the temperature of the atmosphere 
more sultry and oppressive. 

August and September are generally the hottest months ; 
the weather throughout was very unsettled ; heavy rains 
with terrific lightning characterised the autumnal period : 
the mean maximum of the mercury during these months 
was 87°. 

The weather, during the whole month of October, was 
warmer and more unsettled than usual ; November was 
more rainy, and consequently cooler. 

It rained in this parish more than one half of the 
days of the month of December ; some very heavy squalls 
from the north, which carried the low condensed clouds 
into the interior, and so completely enveloped the lofty 
ridges of the blue mountains that they were invisible the 
whole month. 

In the diurnal register of the weather, there is a record 
of two severe shocks of earthquake, and the number of 
days on which rain was observed throughout the year, 
amounted to one hundred and forty-six. 

Commencing with a detail of the diseases which oc- 
curred in January, I find that the cases were, for the 
most part, intermittents. In the Military Hospital, which 
I had charge of at the time, the monthly report was very 
favourable. 

February was unattended with any acute diseases, ex- 
cepting two cases of pleurisy ; these were tradesmen of the 
second cast, id est, mulattoes. 

Catarrh prevailed in March : about the end of the month 
some cases of fever appeared ; the captain of an American 



BILIOUS REMITTENT FEVER. 



223 



vessel had a smart attack, but recovered. The diseases 
amongst the peasantry were generally mild. 

The fevers treated in April were of a very simple 
grade. Exclusive of the admissions in the Military Hospi- 
tal, the number of patients in private practice during the 
month amounted to nine cases of remittent in the town, 
and six seamen on board the different ships in port ; eleven 
cases of intermittents. 

The country practice amongst the peasantry furnished 
eleven cases of catarrh, seven cases of ascites, three cases 
of cynanche tonsillaris, two abscesses, two epilepsy, two 
phthisis — no deaths. 

There were two fatal cases of malignant sore throat in 
May, and the two phthisis patients also died; the parish 
otherwise was healthy ; the military very healthy. 

In June it will be seen that I have remarked that the 
weather was very agreeable, yet there was evidently some- 
thing in the state of the atmosphere capable of producing 
fever, the frequent occurrence of which at so early a 
period of the year, and the season so uncommonly fine, 
was remarkable. The symptoms in almost every case 
were much more aggravated, and put on more of the in- 
flammatory character than usually witnessed. No th with- 
standing these circumstances, there was no death. 

July was pretty clear of fever cases until towards the 
end of the month. There was one case of bilious remit- 
tent fever, which I should not mention but for the peculiar 
circumstances of its being the case of an old seasoned 
European, who had been free from aliment of any kind for 
many years ; he, however, was very ill, dangerously so, 
and, to make use of his own expression, " he was done 
up, and this was his notice to quit he was for once 



224 



BILIOUS REMITTENT FEVER. 



deceived ; he recovered without bleeding ; cathartics were 
chiefly relied upon. 

Old residents and elderly persons were frequently at- 
tacked during the month of August with acute head- 
ache and bilious derangements ; the remittent fever cases 
were more numerous ; and the intermittents of this period 
were very obstinate. I attended one fatal case in the 
latter days of the disease ; it was a case that I was in- 
formed in the early stages assumed the usual uncontrol- 
lable train of symptoms. 

The patient was a young man not many months in the 
country, with a constitution evidently shattered, and con- 
sequently less able to contend against a severe attack. 

The hospitals on the various plantations in the dis- 
trict were crowded with cases of fever neither severe nor 
fatal. 

The diseases of September were similar to the preced- 
ing month. The most obstinate case of fever was an el- 
derly gentleman, a native of the country, the collector to 
the port; he became delirious in the first stage of the 
disease, the illness was protracted until the thirteenth day 
before a remission of the unfavourable symptoms were 
perceived ; the subsequent debility was great; it was several 
weeks before he was convalescent. 

My report to the Deputy Inspector of Hospitals, which 
I forwarded to him this month, has the following re- 
mark : — e< Our fevers for the most part have been mild, 
those that were inclined to be severe have yielded to a 
plan of treatment, at once decisive but effectual, and, as 
yet, no case has terminated fatally. Such patients as came 
immediately under the prompt and vigorous treatment 
were generally young plethoric fellows, whose complaints 



BILIOUS REMITTENT FEVER. 



225 



in the first stage were headache, dimness of sight, pain in 
the back, loins, and shoulders, furred tongue, strong pulse, 
from 100 to 120. These cases were bled to twenty-four* 
and some to forty ounces, before syncope took place. 
Mercurial cathartics and blistering constituted the treat- 
ment, and with most happy results, for the second (attack) 
stage was cut short, and left but little to do in the subse- 
quent stages." 

During October but few cases of fever occurred, either 
in private practice or in the Military Hospital. 

Intermittent fevers were prolonged until the close of the 
year. 



REMARKS ON THE WEATHER AND THE PREVAILING 
DISEASES OF 1818. 

The similarity in the weather for the first three months 
of the year 18J8, with that of the spring of the year 
preceding, was very remarkable ; from January to the 31st 
of March, the climate approximated to the Italian ; the 
temperature of the atmosphere was of that nature, which 
is best calculated to impart the most agreeable feelings to 
the constitution. This is unquestionably the period that 
Europeans should, arrive in the tropics, particularly in 
Jamaica. 

It should be a settled thing for persons who are about 
to quit their native northern climate so to arrange the 
period of their embarkation that they may land in Ja- 
maica, or any other of the West India Islands, early in 
the month of January. The advantages arising out of this 

Q 



226 



BILIOUS REMITTENT FEVER. 



precautionary measure are incalculable ; to all classes, in 
every rank of life, it is of the utmost importance ; it is 
the only and proper period to prepare the system for a 
residence in a warm climate ; it matters not whether the 
emigrant is destined for the bar, the church, the medical 
profession, to be a merchant, planter, or mechanic. And 
it is more essentially requisite that this advice should be 
adopted on the embarkation of troops intended to garrison 
the different military posts throughout the West India 
possessions. The army surgeons have time to look about 
them, have time to learn something of the disposition 
of the men under their charge, have time to acquire some 
knowledge of the diseases of the climate, have time to 
make inquiries from the members of the profession who 
have been years in the country, the best prophylactic 
means of preserving the health of the men ; have time to 
inquire what should and what should not be avoided ; and 
finally, as this period is for the most part free from 
danger, both as regards the diseases incidental to Euro- 
peans in a tropical climate, and the consequent, I might 
say, impunity with which all degrees of exercise may be 
taken in the open air at any time of the day, it is mani- 
fest that a measure which has many benefits springing 
therefrom should always be adopted. 

The second quarter of this year was unusually fine ; in 
fact, the weather was such that there was nothing to pre- 
vent any person from travelling from one part of the 
island to the other until the middle of June ; then it was 
that the periodic rains set in and continued until the end 
of the month. There was an immense fall of rain in the 
month of July, and the temperature of the atmosphere was 
much warmer ; August was fair, calm, and sultry ; Sep- 
tember rainy, hot, and very disagreeable weather. 



BILIOUS REMITTENT FEVER. 



227 



It was somewhat cooler and less rainy during the 
month of October; although November and December 
are generally attended with rain and squalls from the 
north, yet in this year the quantity of rain which fell in 
this district was unprecedented. In November it rained 
twenty-four days, and in December thirteen ; the tempera- 
ture of the atmosphere was cool. 

The diseases of the first quarter were of the mildest 
character. There was no case of fever until the latter end 
of April. This patient had not been many weeks in the 
country ; he resided on a plantation near the sea-shore, 
which has the disadvantage of being near a swamp of 
some extent; since his arrival his occupation was ex- 
ceedingly laborious, such as ploughing the level lands 
contiguous to the swamp : the oxen, not quite so tractable 
as the animals he had hitherto been accustomed to, fre- 
quently produced in this man, which I more than once 
witnessed, extreme vexation, disappointment, and great 
bodily exertion ; day after day he manfully contended 
against these disadvantages until he sickened : he was 
visited a few hours after the attack of fever, and, notwith- 
standing the most energetic measures, the disease made 
such an inroad on his constitution before the tenth day, 
that he was absolutely but a shadow of himself : he re- 
covered very slowly, and shortly after left the country in 
disgust. 

The diseases of May were simple, and need not be 
detailed. 

<£ The peasantry have been and continue to be healthy." 

In June a few mild cases of remittent fever were ad- 
mitted into the Garrison Hospital. The civilians were un- 
affected. 

On the plantations situated near the banks of the Rio 

Q 2 



228 



BILIOUS REMITTENT FEVER. 



Grande, several severe cases of pleurisy were admitted into 
the different hospitals ; the patients were young men from 
twenty to thirty years of age. The free use of the lancet 
in the early stages of this complaint was of signal service. 
Towards the end of the month my attention was called to 
several cases of remittent fever on board the merchant 
ships in port; scarcely a boat returned from any of the 
outports without bringing one or two invalids, in short, 
often in the 'advanced stage of fever. These poor fellows 
suffer incalculable hardships from exposure both by day 
and night ; the occupation of collecting the produce from 
distant barquediers is an employment attended with danger 
at any season of the year, owing, for the most part, to the 
detention the boats meet with from causes I am unacquainted 
with. During this period Jack saunters about, without 
thought takes a drink of poisonous new rum grog, throws 
himself down to sleep, his jacket for a pillow, the earth for his 
bed, no other canopy over him but the sky. Can it be won- 
dered at — can it, I say, be a matter of surprise, that these 
thoughtless mortals so frequently fall martyrs to such im- 
prudent temerity ? The men employed in this way are 
the first to fall sick, and during the autumnal months 
their fevers are of the most formidable description ; but 
few recover. 

The prevalence of fever in July spread a good deal of 
alarm throughout the parish, owing to the deaths of three 
young men, natives of the United Kingdom, who were em- 
ployed in subordinate situations on the plantations. 
There was nothing unusual in the cases ; they had the 
common symptoms, without black vomit. The duration 
of the disease was from five to seven days. It may be re- 
membered here that the black vomit is by no means a 
frequent occurrence in the bilious remittent fever as seen 



BILIOUS REMITTENT FEVER. 



229 



in this parish j and I have reason to suppose this remark 
holds good elsewhere ; the fever must be of the most ma- 
lignant type when it is present. 

It is to be much regretted that the personal comfort of 
the young men filling the situations of book-keepers on 
the estates are not more attended to ; there is, I am in 
truth sorry to say, a sad deficiency in many essential re- 
quisites ; there are exceptions no doubt, but I have seen 
too many instances to the contrary in other parishes be- 
sides the parish of Portland. Generally speaking, this 
desirable end could be accomplished at very little ex- 
pense or trouble to the parties concerned. It has not, I 
am convinced, been properly represented ; but if ever this 
work should fall into the hands of any proprietor of a 
West India estate, let me, in the spirit of sterling impar- 
tiality, implore him to turn his attention to a subject on 
which his own interest and the lives of his fellow-crea- 
tures so eminently depend. 

Proceeding regularly, I find the fevers increased ra- 
pidly in the month of August, and continued during Sep- 
tember ; there were cases to be seen in all parts of the 
parish : it was not confined to those persons who had been 
but a short period in the climate, being manifestly epi- 
demic ; it attacked natives as well -as the old settlers. The 
military did not escape ; they had their share, and a few 
deaths occurred in that department. The seamen were 
also very sickly. The domestics in several families, par- 
ticularly of the mixed races, were attacked with the pre- 
vailing fever — in many cases as formidably and with 
similar symptoms to the European patients. The blacks 
likewise experienced the effects of the epidemic, but they 
suffered in less proportion than any other denomination of 
patients. This I have found to be universally the case. 



230 



BILIOUS REMITTENT FEVER. 



September was particularly oppressive, and the greatest 
mortality happened in this month ; the solar heat on four 
successive days was 130°. 

Amongst the troops and the seamen in port the epidemic 
still existed ; several fresh cases were daily admitted 
during the month of October, but it was evidently less 
virulent; the cases yielded much more readily to the 
treatment adopted. Towards the end of this month the 
negroes suffered severely from cholera morbus ; this for- 
midable disease fortunately did not spread — it was con- 
fined to a small portion of the parish — it only visited three 
plantations. 

There were no fresh cases in civil practice, nor any ad- 
missions of fever cases in the Military Hospital, in the 
month of November ; there were three patients admitted 
with ophthalmia. 

The diseases, generally speaking, during the month of 
December, were of a mild nature, particularly the fever 
cases ; intermittents were numerous, but not obstinate. 

The ophthalmic cases were discharged cured. 

Catarrh and cynanche tonsillaris were frequent in many 
parts of the parish amongst the peasantry ; ascites and 
apoplexia serosa were treated, but to little effect ; — both 
cases died. 



REMARKS ON THE WEATHER AND THE PREVAILING 
DISEASES OF 1819. 

The records of the year 1819 are calculated to strike 
terror into the stoutest heart ; some of the bravest of the 



BILIOUS REMITTENT FEVER. 



231 



brave, the young, beautiful, and fair, were hurried into an 
untimely grave by the fatal effects of an epidemic which 
made its appearance as early as the month of February. 
The commencement was considered an usual occurrence, 
in consequence of the mild nature of the symptoms in the 
month of January, which for the most part consisted in 
cough, accompanied with swelling of the parotid and tonsil 
glands. Before the third week in February almost every 
part of the parish was affected ; there was no discrimina- 
tion as to age, sex, temperament, or colour. 

The white Creole ladies suffered in the greatest propor- 
tion. One remarkable feature in the character of this 
disease was the insidious and unsuspicious nature of its 
attack ; it was not accompanied by any pain, and not until 
some considerable swelling was observed by the patients 
themselves did they apprehend danger, or feel the least in- 
convenience. In this stage, if there had been any febrile 
symptoms present, they must have been particularly mild, 
for in many instances the patients themselves merely re- 
sorted to a few domestic remedies. 

The second stage of the disease was ushered in by 
shivering, succeeded by efflorescence spreading over the 
w T hole body ; this appearance of the skin lasted but a few 
hours ; it vanished with the febrile heat. 

Then followed hoarseness, pain, headache, and thirst ; 
cough, and an accumulation of viscid saliva in the mouth 
and fauces. In about sixteen hours, which was generally 
the duration of the second stage, the tonsils and fauces be- 
came dotted with aphthous eruption, which rapidly ran 
into putrescent ulcers, of so malignant a character, that 
the poor sufferer, in a very few hours after, was placed 
beyond the means of relief. 

It certainly caused very little alarm at this period, and 



232 



BILIOUS REMITTENT FEVER. 



Lad it not been for the celerity with which the disease 
spread from place to place, and the occurrence of several 
deaths, the consequences must have been very deplorable. 

Lest T should be misunderstood, I will briefly state the 
particulars of the case of a young and very accomplished 
Creole married lady, who fell a martyr to this disease. 

The lady alluded to was closely connected in consan- 
guinity with an intimate friend of my own ; on a visit to 
whom one day at dinner T observed her pallid appearance, 
and from the style of her dress I readily perceived all was 
not right, — indeed, her manner altogether was such, that I 
was induced to inquire if she had been complaining ; she 
replied she had been unwell with a slight sore-throat for 
two or three days, but was then better; she partook of a 
light meal, and thought little of her ailment. Her mother, 
a remarkably intelligent lady, had, she informed me, ad- 
ministered some domestic medicine, and had used external 
applications to the neck. She requested me, before my 
departure, to examine her throat. I did so accordingly, 
and observed several ulcers in the mouth and fauces, and 
both the tonsil glands were deeply ulcerated ; she was 
free from pain, and suffered but little inconvenience, 
except in the act of deglutition ; she was free from feverish 
heat, and the pulse only 70. 

I advised, with caution, prompt and active remedies. 

I cannot very well express what were my feelings on 
this occasion ; but, in order that I might not be led away 
from what I considered correct, and at the same time due 
to the family, I lost no time in requesting the assistance 
of a very experienced practitioner. 

We visited her together on the following morning, and 
our close and undivided attention was given to her during 
the remainder of her illness, which, from this period, was 



BILIOUS REMITTENT FEVER. 



233 



but of short duration ; her sufferings terminated on the 
third da j. 

In all human probability, the life of this amiable crea- 
ture, who in a very few months would have been a mother, 
might have been spared. 

I say so with some degree of confidence, from the fortu- 
nate result of many previous and subsequent similar cases, 
which had the advantage of early assistance. 

Venesection appeared to be the sheet-anchor at the 
onset of this most insidious disease ; in every case it was 
resorted to with decided benefit, and in the first stage ; 
the subsequent remedies consisted in the administration of 
an emetic, mercurial cathartics, and saline aperients, 
and, according to circumstances, the warm bath. Decoc- 
tion of bark, conjoined with diluted sulphuric acid, in 
general completed the cure. 

I was myself attacked with this disease on the 26th of 
April. I directed, immediately ? sixteen ounces of blood 
to be drawn from each arm, took an emetic, and in the 
course of the day three half-scruple doses of calomel ; on 
the following morning a saline aperient ; a water-gruel diet 
for two days completed the cure, without leaving any trace 
of debility. 

This epidemic appeared as early as the 25th of January, 
and did not quit the parish till the beginning of May ; all 
classes of the population, as I before remarked, were at- 
tacked with symptoms as nearly uniform as possible,* 

There was nothing peculiar in the weather except the 
constant prevalence of fiery south and south-east winds 
during February, March, and April, accompanied with 
very little rain until the night of the 26th of May ; it con- 

* For the mortality in the different regiments by this epidemic, see Medi- 
cal Topography. 



234 



BILIOUS REMITTENT FEVER. 



tinued rainy and squally until the 31st. May was through- 
out tolerably healthy, but it was insufferably calm and 
sultry, although the mercury averaged only at its maxi- 
mum 83°. 

The whole of June was droughty, with the exception of 
a few very light showers ; and as I have before premised 
that such weather seldom fails to be productive of sickness, 
I entertained serious apprehensions for the approaching 
autumn. Already remittent fever had made its appearance 
amongst the inhabitants 9 and the admissions into the Mili- 
tary Hospital during the month (June) amounted to forty- 
six fever patients. Out of this number there were three 
deaths. The mean maximum of the mercury for the 
month was 84° ; the mean minimum 74°. 

In the month of July, the remittent fever had spread 
considerably over the plains, along the coast, in the in- 
terior, and on several of the more elevated mountain settle- 
ments in the parish. The admissions into the Military 
Hospital during the month were sixty-three ; out of this 
number there were five fatal cases. There were seventeen 
cases in the different ships in port, of which two died. 

In the lower town, in West and Market Streets in par- 
ticular, the fever raged with uncommon malignancy 
amongst that class of people called Mulattoes ; although 
they appeared to combat with the fury of the disease by 
longer struggling, there were, nevertheless, several fatal 
cases. 

Early in August, the officer commanding the detachment 
of troops stationed in the barracks of Fort George, Titch- 
field, was attacked with the prevailing fever ; the particulars 
of his case, which was rather a remarkable one, are de- 
tailed in the observations on the temperature of the system. 
The admissions during this month in the Military Hospital 



BILIOUS REMITTENT FEVER. 



235 



were rather less than the last, viz. fifty -eight ; and, as I 
reported at the time to the deputy inspector, they were 
rather of a milder character. 

It was supposed that the career of the epidemic would 
be arrested in consequence of a heavy fall of rain on the 
10th of August; it rained almost incessantly the whole of 
that day and night, and the discharge of electric fluid from 
the clouds was terrific; however, on the 11th and 12th 
the sun shone forth in unclouded splendour, and made the 
atmosphere as oppressive as ever ; on the morning of the 
13th a refreshing shower cooled the air ; the 14th and 
15th were dry and sultry ; the 16th, 17th, 18th, and 19th, 
the rain fell in torrents a few leagues at sea, but not one 
drop visited the land; from the 20th to the 31st it was 
calm and sultry ; the high mountain peaks were, however, 
frequently capped with dense, heavy clouds, and a few 
occasional showers were seen. 

Before the close of September, the parish became more 
sickly than ever witnessed for many years ; it was next to 
an impossibility to select a spot where the fever did not 
exist along the whole range of coast for a distance of about 
sixteen miles. The plantations in the interior, following 
the banks of the Rio Grande upwards towards its source, 
furnished many severe and fatal cases. The coloured and 
black peasantry were as frequently attacked as the Euro- 
peans ; the hospitals on the different estates were crowded 
with sick. The characteristic features of the severer 
cases were early delirium, great vascular action, black 
vomit, and death, in the space of forty-eight hours after 
invasion. It was no less fatal in its effects during the 
month of October. Several inhabitants of long residence 
in the country had very severe attacks of the prevailing 
fever. 



236 



BILIOUS REMITTENT FEVER. 



Almost every day some fresh patients were added to the 
list ; these, for the most part, were sailors and mechanics, 
whose previous habits of life were such as unquestionably 
produced a predisposition to disease. Independent of the 
effects of irregularity and strong libations of spirits acting 
on the stomach, the constant sympathetic connexion 
existing between that organ and the brain, is it to be won- 
dered at that death made such havoc ? The vessels of 
the brain, by repeated distension and relaxation produced 
by such means, became at length unable to contend against 
a disease of such overwhelming force ; these poor deluded 
creatures became delirious, generally about the termina- 
tion of the first stage of the fever, and, before the interposi- 
tion of remedies could avail aught, collapse and death 
followed in a few hours. 

About the first week of this month, the Bann sloop of 
war arrived in this port from a cruise. I went on board 
shortly after she anchored, and, in my official capacity as 
health officer, asked, as a matter of duty, if they had any sick 
on board. The captain politely referred me to the surgeon, 
who informed me that he had several men sick of bilious 
remittent fever; he was aware of the existence of the epi- 
demic on shore, as he had been informed that the fever 
prevailed at Port Royal and other parts of the island. 
These cases were in the advanced stage of the disease, 
and four of them died in the course of two or three days. 

The purser was brought on shore in a very bad state, 
and died. 

The next case was the captain, who, as soon as he felt 
indisposed, hurried up to my residence, and requested to 
be bled. He was greatly agitated, flushed, and feverish, 
and I directly took thirty ounces of blood from the right 



BILIOUS REMITTENT FEVER. 



237 



arm, put him under a course of medicine, and in five 
days he was convalescent. 

Then followed a fine robust plethoric youth, a midship- 
man. I admitted him also to an apartment in my house ; 
I adopted nearly the same plan of treatment in the first 
stage of fever with this patient as I had in the captain's 
case, but not with the same happy result — the disease 
was much more intractable. On the fifth day, when I 
gave up all hope of his recovery, the vessel sailed for 
Port Royal. The Captain left him with agonized 
feelings. At this moment the youth was delirious, 
and did not recognise him. He (the youth) remained 
in this state for several days, but eventually recovered. I 
had him removed to the residence of the rector of the 
parish as soon as it was possible. 

I cannot omit saying, that the rapid recovery of this 
youth was mainly owing to the great attention and kind 
solicitude of this good-hearted old man. His domicile 
is about seven or eight hundred feet above the level of the 
sea, and is certainly a very healthy spot. 

November set in with a torrent of rain, and it continued 
raining day and night until the morning of the 7th ; it 
blew a gale from the north, and the temperature of the 
atmosphere in consequence became considerably cooler ; 
the north wind continued until the 12th. Up to this 
period very few fresh cases of fever were admitted into the 
Military Hospital, and it was less frequently met with in 
town and country. 

It rained heavily again on the 16th and 17th ; from the 
18th to the 23rd it was fair, with a strong north wind. 
There were some partial showers between the 24th and 
27th ; the remaining days of the month were fair. And 



238 



BILIOUS REMITTENT FEVER. 



here terminated one of the most fatal epidemics that ever 
visited this parish. In my communications with the dif- 
ferent military posts in other parts of the island, I am in- 
formed that it raged with terrible violence, confining itself 
chiefly to the 50th, 91st, and 92nd regiments. 

December of this year was for the most part healthy ; 
very few cases of fever were met with. 

The first case of this epidemic was seen on a plantation 
not far from the town, the road to which is about mid dis- 
tance between Port Antonio to the spot where the road 
encircling the Eastern Harbour quits it for the Windward 
Road. It is inland about half a mile, and a small river 
runs through it ; the buildings are situated in a vale sur- 
rounded on all sides with hills of considerable elevation ; 
it has the advantage of the land but not of the sea breeze. 

A child about seven years old was attacked on the 27th 
of January ; then followed one or two cases which were 
soon relieved. 

It travelled more inland to the southward, and returned 
again, visiting the dwellings on the banks of the Rio 
Grande and the plantations adjacent to the sea-shore to 
leeward. 

By the 1 4th of February it was met with in every part 
of the parish, and before the end of the month several new 
cases appeared in the town. The first of these were 
three white Creole ladies, all attacked nearly at the same 
time ; it itinerated on from place to place, and at length 
ascended the more elevated residences overlooking the 
town, where the air is very pure ; in one residence there 
were two ladies attacked, and the first which I have no- 
ticed terminated fatally ; indeed, it was no less severe and 
malignant here than it was in the town, the plains, and 



BILIOUS REMITTENT FEVER. 



239 



in the valleys. It lost none of its activity until the end of 
April. It was the most fatal epidemic of the kind ever 
witnessed in the parish ! 

I will not attempt to advance any speculative hypothesis 
as to the cause which assailed the mucous tissues and the 
glandular system of old and young. It is not my wish to 
mislead. I have briefly and perspicuously stated facts, 
noticing all the vicissitudes of the season ; and, by thus 
clearly divesting the subject of all mystery, I leave it to 
reasonable minds to form their own conclusions. 



REMARKS ON THE WEATHER AND THE PREVAILING 
DISEASES OF 1820. 

I proceed now in regular order to the year 1820, and find 
the records of the month of January specify that the parish 
throughout was healthy, and the weather cool. 

The month of February was equally fair, and but few 
acute diseases prevailed. 

North winds were frequent. 

March fair throughout, and unattended with diseases 
worthy of notice. During the month of April the weather 
was more unsettled, cloudy, and rainy. Persons inhabiting 
the dwellings situated near to Port Antonio River were at- 
tacked with bilious cholera and enlargements of the spleen ; 
these complaints required simple treatment ; almost all the 
children of the mixed races in this part of the town are 
subject to these diseases, and many of them are often 
carried off very suddenly by convulsions, for the most part 
occasioned by worms. 



240 



BILIOUS REMITTENT FEVER. 



May passed without the occurrence of any disease which 
could be considered of consequence, and the weather was 
fair. 

June, in point of the vicissitudes of the weather, was 
very boisterous, rainy, and squally; there was, however, 
but little sickness in the parish. In July, the diseases 
were more numerous and more formidable. Remittent 
fever was frequent ; variola, rubeola, catarrh, and affec- 
tions of the bowels. 

The deaths were few. 

These diseases existed during the month of August ; 
the weather was sultry, with an equal proportion of rain. 

The fevers and other diseases of September had no- 
thing which could give rise to the least alarm, either in the 
symptoms or frequency of cases. 

A very troublesome influenza made its appearance early 
in October, and continued during the month ; some very 
severe cases were witnessed ; elderly females suffered very 
much, and several deaths occurred. Young adults rallied 
through the disease, with comparative ease, in a few days ; 
one bleeding and aperient medicines in the early stages, 
warm clothing, quietness, barley-water, and diaphorites 
completed the cure. In some cases, however, these reme- 
dies, although they appeared to relieve the symptoms, 
and evident signs of recovery were manifest, metas- 
tasis of the bowels supervened, which ended in a trouble- 
some diarrhoea, and by this untoward event many deaths 
amongst the labouring class of our peasantry took place. 

The weather was very variable ; sultry, with but little 
breeze either during the day or night. November was 
very fine, with very little rain ; a few cases of remittent 
and tertian fever appeared in the windward part of the 
parish, neither obstinate nor fatal. 



BILIOUS REMITTENT FEVER. 241 

During December the parish throughout was healthy ; 
the weather was cool and pleasant ; the mean maximum 
of the mercury in the lower town 80°, the mean minimum 
70°. This closes the remarks of the year 1820. 



R 



242 



CONCLUDING REMARKS 

ON 

EPIDEMICS. 



A retrospective statistical report of the various epidemics 
which have appeared in Jamaica since the year 1815 to 
the year 1838, must for the most part be imperfect, because 
no exact registry of the deaths which took place in the 
different parishes throughout the island has been made. 
This is much to be regretted, and I find it would be an 
extremely arduous undertaking even to attempt to make 
a general historical survey of the occurrences even in a 
condensed form, owing to the scarcity of data, and the 
want of a correct census of the population in each parish. 
In glancing over my own statistical reports, and comparing 
them with those of the military which have been so ably 
condensed by Major Tulloch from the annual returns sent 
to the inspector-general's office, I find that the inhabitants 
have suffered more or less in the ratio of mortality, at the 
very periods when the epidemics appeared at those places 
where the troops were located. 

In the month of December of the year 1829 it may not 
be uninteresting to mention the peculiarities of an epidemic 
influenza which prevailed in many parts of the island, at- 
tacking old and young. It first appeared in Manchioneal, 
a parish situate near the north-east of the island, from 
whence it gradually travelled along the coast westward, 
passing the town of Port Antonio to the confines of Saint 



BILIOUS REMITTENT FEVER. 



243 



George : it did not quit the town and many inland plan- 
tations until the end of the month ; the greatest mortality 
took place among the peasantry, a great number of whom 
died. There was not one instance, as far as my informa- 
tion extended, of an European or white Creole inhabitant 
having died of the disease, although in many cases the 
symptoms were severe. 

It was ushered in by the following symptoms in the 
first stage — headache and cough, with slight pyrexia ; 
the second stage, rigors preceded the fever ; the cough be- 
came more distressing, with pain in the chest, and diffi- 
culty of breathing ; the pulse in this stage was weak and 
rapid, and continued so during the continuance of the 
period of forty-eight hours ; in the third stage, the rigors 
were more frequent, pyrexia daily, laborious breathing, 
great prostration of strength, the pulse weak, and often 
tremulous ; the patients in this stage very rarely endured 
the recumbent posture : whenever the period of this stage 
extended beyond the third day, the patients became ex- 
tremely emaciated : diarrhoea supervened, from which few 
recovered in whom this metastasis was observed. 

The white inhabitants obtained considerable benefit 
from bleeding in the early stage ; and it was a remarkable 
fact, that if this remedy was adopted later than the com- 
mencement of the second stage, the patients sank into a 
state of debility immediately after : it was rarely requisite 
to bleed a second time, even during the severest symptoms 
of the disease. The native black and coloured inhabit- 
ants rarely stood the operation of bleeding to the extent 
of sixteen ounces before they fainted. 

Tartar emetic, and saline aperients, were of signal 
service. Blisters were also invaluable. The treatment 
consisted in fulfilling three indications, viz. first, to re- 

r 2 



•244 



BILIOUS REMITTENT FEVER. 



lieve the congestion and inflammatory action ; second, to 
subdue the spasmodic cough, deep-seated pain, and pro- 
mote expectoration ; third, to support the strength by 
appropriate means. 

To investigate the causes which influence the appear- 
ance of epidemic diseases, or to inquire by what laws 
epidemic diseases invade different countries and places, 
under all the strange modifications which each particular 
epidemic assumes, whether in the frowning and cadaverous 
aspect of cholera ; the loathsome and malignant variola ; 
whether it approaches under the treacherous mask of 
influenza^ or in the mysterious and changeable garb 

* Of influenza, or epidemic catarrh, we have no account before the four- 
teenth century, when it appeared in Italy in the month of July in the year 
1323, in 1327, and 1358. It visited France in 1387. The records state that 
old people were the greatest sufferers. It invaded France and Italy five 
times in the fifteenth century viz. in 1403, 1410, 1411, 1427, and 1482. 
In the sixteenth century, in 1505 and 1510, it overran Italy, France, and 
Spain ; by it Ann, the wife of Philip the First, was carried off, and the life 
of Pope Gregory the Thirteenth put in jeopardy. It overspread the entire 
of Europe in the several years 1557, 1559, 1574, and 1580, passing over a 
part of Asia. It was not generally fatal except in Italy, where it is said 
the lancet was too freely used ; nine thousand perished by it in Rome alone. 

Vilalha says it almost depopulated Madrid ; and so rapidly did it spread 
in Barcelona, that in the space of twelve days twenty thousand persons were 
attacked. In 1590 -91 it appeared in France, Germany, and Italy. 
In 1658 it prevailed in London, and is well described by Willis. In 1663 
we find it in the Venetian States, where it was very fatal. 

In 1665, 1669, and 1676, it spread over Germany and France, and visited 
England. Sydenham, who gives a description of it, says it seized entire 
families together. In 1679 it again spread through England ; and in 1691 
through Hungary, Carniola, Styria, Carinthia, the Tyrol, Switzerland, and 
along the banks of the Rhine. Early in the eighteenth century it prevailed 
in France, Prussia, and Italy. In 1729 it overran Russia, Poland, Hungary, 
Germany, Sweden, Denmark, France, Italy, Spain, and again in England ; 
never before had it been so general. It appeared in Barbadoes in February, 
1733, and from thence it travelled to Jamaica ; then turning to the south-east, 
it spread over Peru and Mexico, having the same characteristics as in Europe. 



BILIOUS REMITTENT FEVER. 



245 



of typhus, or how they visit the haunts of man, borne on 
the wings of the wind from the four quarters of the world, 
at times when all their suspicions are lulled to rest in the 
confident security of health — the mind abstracted in the 
active pursuits of business, or the alluring scenes of plea- 
sure, only awaked to a sense of danger when the enemy 
is absolutely within the camp, entering alike the tent of 
the prince and the peasant, and exerting all its potent 
power, spreading the mantle of desolation over thousands, 
hurrying them into the vale of the shadow of death 
without warning — " no reckoning made, with all their 
imperfections on their head ;" — may be attempted, but 
with w T hat success is extremely doubtful. Centuries have 
passed marked by eras rife with plague, pestilence, and 
famine, — with every disease to which frail mortals are 
liable ; but do we know why or wherefore, or are we 
better informed as to the true cause of these aerial visita- 
tions ? The answer is obvious — the circumstances con- 
In 1737 it was in England, according to Huxham's account ; and in 1742 
it once more passed through Holland, France, England, and Italy. 

It was in Scotland in 1762. In 1775 it once more overran Europe, 
attacking man and beast. It is stated that on this occasion it first got the 
name of influenza, — an Italian word, referring to the supposed malignant 
influence of the elements. 

France and England were attacked by it in the year 1780. In the former 
it got the several names of la follette, la coquette, la grenade, &c. In 1782 
we hear of it as having been very severe in Russia, Sweden, and Germany. 
There is a curious fact related regarding the rise of the mercury at St. 
Petersburgh ; on the night of the 2nd of January, Fahrenheit's thermometer 
rose from thirty-five degrees below zero to five degrees above. The Germans 
gave it the name of blitz katarrk, (lightning catarrh,) from its sudden inva- 
sion. In the year 1813 it was once more in France ; and we have it again 
in England in the years 1817 and 1833. 

The detailed accounts of these epidemics ascribe the invasion to the sudden 
relaxation of great cold, and substitution of moist weather. Other causes, no 
doubt, were in operation. 



246 



BILIOUS REMITTENT FEVER. 



nected with epidemics are so innumerable, so vast, and so 
inexplicable, — so dependent on invisible agencies, acting 
under cover in all climates, sparing no country, as far as 
our information extends, except the polar regions.* These 
aerial enemies of mankind, which have hitherto defied the 
elaborate analyses of ancient and modern chemists, are 
extremely vague and capricious in their movements, flying 
from place to place, from district to district, over con- 
tinents or in islands, and rarely assuming the same 
characteristics, sometimes in a mild, but more frequently 
in a virulent form, probably fulfilling the design of the 
All-wise. Man may speculate on the various phenomena 
presented to his view, but with what success he may 
attain the desired solution of the truth, compared to the 
extent of his reasoning power, must depend upon " his 
Creator's designs." However great the desire may be to 
achieve the end in a satisfactory manner, we must, I fear, 
in the plenitude of our pride, with our present store of 
knowledge, arrive at the humiliating conclusion of con- 
fessing that the task is one of such fearful magnitude as 
to be beyond the reach of human skill. 

" Man not only sees means directed to certain ends, 
but ends accomplished by means which he is totally 
unable to understand; he also sees everywhere things 
the nature and the end of which are entirely beyond his 
comprehension, and respecting which he is obliged to con- 
tent himself with simply inferring the existence of design. 1 ' 

Epidemic diseases are said to depend upon a specific 
miasma or contagion, or upon more general causes; but 

* And there, on the shores of the Baltic, and the Frozen Ocean, it has 
been ascertained that the average of human life is double the duration, 
compared to what may be imagined as a correct estimate of the average life 
of man in the genial climates of France, Italy, or Greece. 



BILIOUS REMITTENT FEVER. 



247 



what these causes are we know not — at least they have 
never been defined.* We are frequent spectators of effects, 
mournful and distressing effects ; and, accustomed as we 
are to minister to the sufferings of our fellow- creatures, 
we cannot help shuddering amidst such scenes of woe. 
It behoves us, then, to exert the best, all the energies of 
the mind, to assuage their sufferings under the affliction of 
disease. 

The annual returns afford information on many interest- 
ing topics, besides the deaths by various diseases, whether 
acute or chronic ; the temperature and state of the wea- 
ther, the fall of rain, and other vicissitudes which may 
have had influence on the health of the troops and the 
inhabitants generally, and how far each class has been 
affected by such agencies. 

Of the number of officers serving in the island of Ja- 
maica from 1821 to 1836 inclusive, who have been at- 
tacked with fever, one hundred and three have died 
out of five hundred and sixty-five treated. The greatest 
mortality appears to have been during the epidemics 
of 1822, 1825, and 1827; in the former year one fifth 

* If we were to divest ourselves of the prejudices and jealousies, which I am 
sorry to say have created such warfare amongst the profession, we should be 
enabled with more certainty to arrive at the truth. A dispassionate inquiry into 
the causes of disease arising from malaria, in any locality, no matter where* 
whether on shipboard, in a street, or a lane, or even when confined to a single 
building, would be the means of unveiling much of the mystery which at pre- 
sent exists. Cleanliness and thorough ventilation do, in my opinion, disarm 
the aerial monster of a vast proportion of its power or potency. The causes of 
certain very fatal effects by fever, both aboard and at home, have been traced 
and positively discovered ; I could instance several, besides the facts on board 
H. M.S. Pyramus and the house at Manchioneal, in which a detachment of the 
22nd regiment suffered severely. When I shall have obtained a sufficient num- 
ber of incontrovertible facts in support of the opinion I am disposed to advance 
on the subject, I will offer them to the scrutiny of the world. 



•248 



BILIOUS REMITTENT FEVER. 



of the number died, amounting to twelve ; in the se- 
cond, twenty-seven died, being about one-third of the 
number treated ; in the third, seventeen out of sixty died. 
From that period, in the subsequent epidemics, out of two 
hundred and seventy -two only thirty-one died, a little 
more than one-ninth. 

Of the deaths among the troops during the above 
period of sixteen years, the average appears to be about 
seven and a half of the total number of remittent fever 
cases admitted into the different hospitals throughout the 
island, — the years 1822, 1825, and 1827, being the most 
fatal. 

Of the black troops and pioneers, I find, out of two 
hundred and seventy-four admissions under the head of 
Feb. Remittens during sixteen years, thirty-four deaths. 

The mortality of the troops at Up-Park Camp alone, 
during the above period, amounts to one thousand and fifty- 
two — averaging a little more than sixty-five annually. 

It would appear, as Major Tulloch remarks, that the 
mortality of this class of troops in Jamaica is but thirty 
per thousand of the strength annually ; so that the climate 
must be much more favourable to their health than that of 
the windward and leeward command, where the mortality 
among the negro troops was ascertained to have been forty 
per thousand, on the average of the same series of years. 

The superior salubrity of Jamaica for the negro race is 
corroborated by the mortality of the negro population 
being only twenty-five per thousand of all ages, while 
throughout the windward and leeward command it is 
thirty-one per thousand of all ages. Thus, both in regard 
to black troops and the negro population, the mortality is 
one third less in Jamaica. 



249 



NOTES. 



Note A Page 210. 



There was very little difference in the age of these patients ; 
they were all young, and mostly active, robust tars ; some had, 
some had not, been in a tropical climate before. The symptoms 
were nearly uniform, except in a few cases, which were marked 
by nervous irritation from the invasion to the termination of the 
disease. It is a fact worthy of observation, that bleeding could 
not be carried to the extent in these cases which some practi- 
tioners have recommended. I found it difficult to obtain six- 
teen ounces, except when I was induced to open the temporal 
artery. This was early resorted to in patients of the phlegmatic 
temperament ; they generally fainted at the loss of very little 
blood. In the other sanguine, rigid temperaments, from twenty- 
four to thirty-two ounces of blood could be taken, without diffi- 
culty or danger, at one bleeding ; and I sometimes found it 
necessary to repeat it in the first stage. The gastric symptoms 
were present in all ; the irritability of the stomach more dis- 
tressing in some than in others. The duration of the disease, 
from the invasion to the termination, either fatally or to a re- 
mission of all the symptoms, was generally from three to five 
days. The average deaths were one in four. 



250 



NOTES. 



Note B.— Page 211. 

The mixed races, such, for instance, as Quadroons, Mulattoes, 
&c, rarely, during the epidemic, had any gastric symptoms 
or irritability of the stomach; indeed the type of fever ap- 
peared less complicated, and, except those instances which 
terminated fatally, the fever might for the most part be deno- 
minated simple fever, which required prompt but milder means 
to effect a cure. The blacks sometimes sank rapidly ; I 
allude to the fatal cases only ; indeed, in sickness generally 
they are a chicken-hearted race, and readily give up all hope, 
particularly when they behold more than an ordinary number 
of their race sick at the same time. Bleeding was seldom 
required ; blisters and cathartics were indispensable, and, when 
promptly administered, speedily effected a cure. This is not 
such an extraordinary circumstance as a cursory glance might 
infer, because when we take into consideration the customs, 
manners, habits, and temperaments of this race of beings, 
who have many natural peculiarities which Europeans are 
without, we cannot wonder that they are less liable to attacks 
of this fever, and more likely to recover from it, when they 
are attacked, than the white and mixed races. In the experi- 
ments which I have made at different seasons of the year, 
relative to the temperature of the skin at various ages, in 
health and under the influence of fever, some curious facts 
have been elicited, which will be seen in this work. 



Note C Page 212. 

These changes in atmosphere may likewise be accounted 
for at this period, and I think satisfactorily. Let us suppose 



NOTES. 



251 



the season to be at times exceedingly sultry ; let us suppose 
the usual sea-breeze either wanting, or, at all events, but 
irregularly prevailing ; let us suppose, in consequence, the pres- 
sure of the atmosphere to be great — a circumstance demon- 
strated by the flight of the swallows, which may be seen 
skimming their aerial flights very near to the earth in search 
of the numerous insects which abound in the tropics, and are pre- 
vented by the weight of the atmosphere rising as high from 
the surface of the earth as they would otherwise in a less 
dense atmosphere; consequently, the noxious vapours which 
arise become readily incorporated with the circumambient 
air, and are of course inhaled, and continue to be so until a 
more wholesome supply of air is substituted. 



APPENDIX. 



STATISTICS OF THE NAVY. 

YEAR 1830. 

To ascertain the influence of climate on health in the 
most satisfactory manner, it would be desirable to consider 
that of the West Indies and of North America separately. 
It would lead to more correct conclusions to have a set of 
tables indicating the ratio of sickness, invaliding and 
death in each, the Bahama Islands being classed with the 
West Indies. The Bermudas form a kind of neutral 
ground, a connecting link between the West Indies and 
British North America, possessing some of the features of 
each, but not generally having the well-marked character 
of either. Their appreciable climate and morbid mani- 
festations, however, are more West Indian than North 
American ; and it would therefore be right, if not taken by 
themselves, to group them with the former rather than 
the latter. But the whole being under one commander-in- 
chief, and the vessels continually changing places, passing 
from intratropical to extratropical latitudes, and vice 



254 



APPENDIX. 



versa, such tables cannot be constructed. The necessary 
materials are wanting, and therefore the general views 
which the student of medical statistics would desire to 
deduce from them, cannot be fully obtained. 

Whether this disposition of the naval force in those 
seas is, on the whole, conducive to the health of seamen, 
it is not easy to determine. Whether it lessen mortality 
from pure West Indian fever is a difficult question, as 
are many other questions connected with that destructive 
disease. But whatever effect it may have in that respect, 
it is pretty evident that it has in some respects a detri- 
mental effect, while in some others, again, it is beneficial 
to health. The difficulty is, to ascertain on which side 
is the preponderance : to know whether the arrangement 
in question of the naval force contributes, and in what 
measure, to the conservation of health and reduction of 
mortality. The question, though difficult, is highly im- 
portant, and ought to be carefully examined. 

The diseases, forming a large portion of all those af- 
fecting sailors, occasioned by sudden and great changes 
of natural temperature, whether the change be from a 
higher to a lower, or the contrary, will certainly be in- 
creased in number, if not aggravated in force, by the con- 
stitution of a squadron like that under consideration. A 
ship passes in a week or two from one place, where the 
thermometer stands at 70°, 80°, or higher, to another where 
it is far below the freezing point ; hence frequent attacks 
of catarrh, visceral inflammation, and rheumatism; or 
she passes in the contrary direction at the same rate, and 
the surgeon's list is crowded with diarrhceal, dysenteric, 
choleric, and symptomatic febrile cases. Were she not 
so exposed, she would not suffer to the same extent in 
that way. In and on the confines of the Caribbean Sea ? 



APPENDIX. 



255 



or what at one time constituted the West Indian command, 
original inflammatory diseases of a graver kind are little 
known ; and when ships passed the whole period of their 
service there without change, the loss resulting from such 
forms of disease made a very small part, if they con- 
stituted an ingredient at all, in their total of mortality. 
Now, taking the entire command, they, as well as other 
diseased actions arising from sudden changes of tempera- 
ture, are frequent, if not frequently fatal, much increasing 
the number of sick thus originating, and leading in many 
instances, if not to fatal terminations, to the necessity of 
invaliding. 

These are the evils, as they regard health, arising from 
the composition of such a squadron, comprising climates so 
conflicting, and extending from the equator to Baffin's 
Bay ; but there is no doubt that it likewise possesses ad- 
vantages, whether equivalent, or less or more than equiva- 
lent, to the admitted evils, it will require much observa- 
tion to determine. One obvious benefit consists in the 
vigour infused by change from the West Indies to Halifax, 
the Gulf of St. Lawrence, or the coast of Labrador. 
Many men whom, but for such change, it would be neces- 
sary to send to England as invalids, not only continue to 
do their duty, but, after a while, return to the West 
Indies strong, remain well, and are more serviceable than 
new hands would be. Many men, besides, who were 
doing their work without complaint at the time the ship 
sailed from the West Indies for the North, would, in a 
few months more, have been in a similar state of disease 
or debility, requiring, if such change in the place of 
service had not happened, by the urgency of their symp- 
toms, change of climate, as invalids, at once increasing 



256 



APPENDIX. 



expense, and reducing force. It is believed by some, that 
absence for a certain length of time from the West Indies 
in a cold region increases susceptibility to attacks of the 
fever peculiar to the country, lessening or destroying the 
protecting power of acclimation derived from former 
residence. But there is reason to doubt the soundness of 
that belief ; and one thing — an important one connected 
with the subject, is certain — namely, that the weaker the 
subject is, other things being the same, the more exposed 
he is to that formidable disease. In this view, a view 
which will be scarcely disputed, such a change, inasmuch 
as it increases physical power, will render him less, rather 
than more, susceptible. 

Though the number of vessels of all descriptions em- 
ployed was forty -seven, the majority of them being of the 
smallest class, the mean annual force amounted to no 
more than 3,326. The total number of sick and hurt 
was 5,070, a very large proportion, being at the rate 
of 1524*3 per 1,000. Of all the sick and hurt, 313 were 
sent to foreign hospitals, being at the rate of 95 per 1,000 
nearly, likewise a large proportion. From various ships 
138 were invalided, being at the rate of 41*4 per 1,000, 
and forty were invalided from hospitals, making a total of 
178 invalided during the year, and being at the rate of 
55*3 per 1,000 of mean strength. Out of so large a number 
of sick, however, only twenty-one died on board ship, 
yielding the very low ratio of 6*3 per 1,000 ; but fifty-four 
of hospital cases terminated fatally, making a total of seventy- 
five deaths ; the ratio of the total of mortality of mean annual 
force being 22'5 per 1,000. The number of hospital esta- 
blishments within the limits of the station, and the conse- 
quent facilities of sending sick to them, when attacked by 



APPENDIX. 



257 



by fever at Port Royal at once to hospital, will account 
for the relatively small number of deaths at sea. 

The loss to the service resulting from death, whether at 
sea or in hospital, was not great. In most tropical posi- 
tions it would not be considered severe, and is anything 
but formidable, the West Indies being a large portion of 
the field of service ; but the loss to the squadron from 
invaliding was certainly considerable, and deserves con- 
sideration. Without entering on the question, whether 
all the instances of invaliding were necessary in reference 
to the health only of the subjects thus disposed of, — the 
process being sometimes resorted to for other purposes, — 
and whether due care had been taken, in manning ships, 
always to enter men little likely to require invaliding in 
the period of the service, — questions which, though impor- 
tant, and not limited to that station, it might not be proper 
to discuss in this place, without entertaining those general 
questions, — the most remarkable circumstance, on examin- 
ing the invaliding column, is the small number found in it 
resulting from essential fever, and the proportionably 
large from the pure forms of inflammatory disease, viz. 
five from the first, and fifty-four from the last, on board 
ships. It is the more remarkable as regards fever, con- 
sidering the number of cases of periodic fever found in the 
medical returns, which so frequently require, sooner or 
later, to be invalided ; and it cannot be doubted that the 
smallness of the number on this occasion depended, in 
part at least, on the favourable change of climate, from 
hot to temperate or cold, which the nature of the command 
permitted men so affected occasionally to enjoy. But the 
change of climate which was favourable to those sub- 
jects, to the weak generally, but especially to those 
labouring under the habit and habitually depressing power 

s 



258 



APPENDIX. 



of ague, would increase the number of inflammatory 
attacks, and would contribute powerfully to the effect 
noticed above, — the large number invalided on account of 
those attacks. 

The number of cases of idiopathic fever amounted to 
759 ; many of them, however, were so slight and tran- 
sient as to be designated ephemeral. It would be well, 
instead of calling such affections fevers, to trace them 
to the local cause of disturbance on which they depend, 
and give them their proper name. The whole are divided, 
according to the medical returns, into 586 of continued, 
eighty -four of remittent, and eighty nine of intermittent, 
fever ; of the first, eighty-six were sent to foreign hospitals, 
four were invalided, and five ended in death on board : 
of the second, forty-eight were sent to hospital, and two 
terminated fatally on board ; and of the last, eight were 
sent to hospital, and one terminated fatally on board. It 
is curious, that out of all the cases of periodic fever so often 
requiring invaliding, not one was so disposed of ; while 
four of the continued cases, where perfect recovery, when 
it takes place, is so much more common, were sent to 
England for change of climate. 

The Blossom (surveying ship) suffered more than any 
other vessel from a fever designated remittent. She had 
seventy-six cases, forty-six of which were sent to hospital, 
where ten terminated in death, and two deaths occurred 
on board. The disease broke out, and ran its course, in 
a few weeks, off Belize, a position abounding in the cause 
of periodic fever, two days after the ship's arrival there 
from the anchorage at Port Royal. There is difficulty, as 
there generally is, in tracing this fever, which appears to 
have been the true endemic West Indian fever, not or- 
dinary remittent, to its source. No fever of the kind 



APPENDIX. 



259 



existed at Belize, or other point in the Bay of Honduras, 
at the time it broke out in the Blossom, nor does any 
appear to have occurred during its course. The necessary 
conclusion therefore is, that the cause of the disease was 
either generated in the ship, being an intrinsic product of 
herself, or was derived from an extrinsic source, at some 
place where she had previously been, having lain so long 
dormant in the persons of those afterwards affected. The 
surgeon of the ship inclines to the former opinion, but 
confesses the difficulty of the subject, and does not enter 
on its discussion. He states that, while at Nassau, in 
April (the fever broke out in July at Honduras) the ship's 
holds had been emptied, cleaned thoroughly, white- 
washed, and completely dried and ventilated, prohibiting 
the notion of want of interior cleanness having anything 
to do with the production of the disease. Such processes 
of dealing, perfectly cleaning, and then re-stowing ships 
of war in the West Indies, with the view of guarding 
against invasions of fever, are common ; but it is a fact, 
however startling or difficult of explanation, that they are 
very generally followed, in no long period, by a serious 
visitation of the disease. What relation there is between 
the purifying process in question and the subsequent 
eruption of fever, if it be an operative relation, may never 
be satisfactorily known ; that the one frequently, generally, 
follows the other, is certain. 

In the Grasshopper there were forty-eight cases of fever, 
designated inflammatory, two of which terminated fatally 
at sea, and one was sent to hospital. The disease pre- 
vailed principally in the Bay of Honduras and on the 
Mosquito shore. It is not easy to ascertain the precise 
nature of the disease in this case, but its power was not 
great. Immediately before sailing for Honduras, the ship 

s 2 



260 



APPENDIX. 



had been some time at Port Royal refitting — kind of refit- 
ting not stated. The surgeon ascribes the disease to drunk- 
enness, and other irregularities indulged in by the ship's 
company. Such agents might render them more liable to 
the action of the cause of the fever ; they could not of 
themselves, it is assumed, produce it. The essential 
cause, whatever it might be, of the primary cases, was 
probably received at Port Royal. 

The Icarus had twenty-nine cases of fever, which are 
designated mixed : sixteen of them were sent to hospital, 
where four ended in death. She was employed at Port 
Royal and Chagres, and in passages between those places. 
In the latter place the cause of remittent fever, and of 
other fevers of type, is rife. Besides the above cases of 
continued fever, she had twenty-nine cases of ague. In 
this vessel, then, it would appear that there were two dis- 
tinct fevers, the cause of one being derived probably from 
Port Royal, and of the other from Chagres. 

In the Magnificent there were forty-seven cases of con- 
tinued fever, divided into thirty- six inflammatory and eleven 
mixed ; thirty-six of the whole number were sent to hos- 
pital, where sixteen terminated in death. There is little 
doubt that the disease in this instance, however designated, 
was, in the majority of cases at least, the true endemic 
West Indian fever — a peculiar product of the soil and 
climate, similar in some respects to, but not identical with, 
the bilious remittents of many other tropical positions. 
The Magnificent is a harbour duty ship, anchored close 
to the shore of Port Royal, and the neck of land called the 
Palisades — places pregnant with the cause of the fever 
in question. There is reason to believe that the essential 
cause of the disease is never wanting there, though it 
exists in various degrees of force at different times, and its 



APPENDIX. 



261 



operation is influenced by the presence or absence of many 
accidental auxiliary circumstances, having the power of 
rendering the body more or less susceptible of its action. 
The ship never enjoys to any extent the comparative pro- 
tection which is derived in other ships from previous at- 
tacks of the disease, on account of the ship's company 
continually undergoing change. She receives, besides 
men discharged from hospital, detachments from England, 
and other disposable portions of the naval force, to wait 
the arrival of ships they are ordered to join — men sus- 
ceptible of fever in various degrees, some of them highly 
so ; and hence she is always peculiarly exposed to attacks 
of the disease, though on the same account, the mixed 
materials of her crew, it seldom assumes an epidemic cha- 
racter in her. 

Fever occurred in many other ships, and prevailed in 
some of them to a considerable extent, but it generally 
had little force ; and, on the whole, the year 1830, though 
the loss in some ships was rather severe, cannot be con- 
sidered unfortunate as regards West Indian fever, espe- 
cially when compared with many other seasons. 

Although the pure inflammation with fever (order 
Phlegmasia?) amounted to 1,468 cases, only four deaths, 
viz. two from inflammation of the lungs, one from in- 
flammation of the bowels, and one from inflammation of 
the throat, resulted from the whole on board ; but forty- 
eight were sent to hospital, and fifty-four, as already 
stated, were invalided : so that the temporary or perma- 
nent loss to the squadron was not inconsiderable. A great 
majority, however, of all the cases included in this order, 
were phlegmonous, and other topical inflammations, 
having little, if any, febrile disturbance, and had better, 
perhaps, been placed in the class Locales. Next in order 



262 



APPENDIX. 



of frequency were rheumatic cases ; after which, inflam- 
mations of the lungs, of the liver, and of the throat, were 
most numerous, many cases of each occurring. 

Including haemorrhage from the lungs, there were thirty- 
six phthisical cases ; of which, thirteen were sent to 
foreign hospitals, eleven were invalided, and two ter- 
minated fatally at sea, leaving ten under treatment at the 
end of the year on board. How far the frequent and 
notable changes of temperature experienced by the people 
in this command may contribute to the induction of true 
tubercular phthisis, it is difficult to determine, but they 
probably occasion a great deal of chronic bronchial dis- 
ease, with which true consumption of the lungs is some- 
times confounded. 

The catarrhal cases amounted to 556, of which four 
were sent to hospital, and one proved fatal at sea. 

There were forty-seven cases of dysentery, four of which 
were sent to hospital. No one ended in death, and none 
required change of climate. 

Diarrhoea was, as might be expected, frequent. There 
were many cases of common cholera, one of which was 
fatal, the only death which happened in the order Spasmi, 
though 488 cases were treated. 

There were 139 cases of all forms of venereal disease, 
viz. sixty-four of syphilis, thirty-nine of gonorrhoea, seven 
of stricture in the urethra, fourteen of bubo, and fifteen of 
diseased testicle. Of the two last forms of disease all 
might not have a venereal origin, but there is little doubt 
that most of them had. Nine of the syphilitic cases were 
sent to hospital ; one of the gonorrheal and a case of 
bubo were invalided, all the other men affected being 
cured on board : the detriment sustained by the disease 
was therefore not great; most of it was contracted at 



APPENDIX. 



263 



Halifax, and other northern parts. In the West Indies 
syphilis is comparatively rare, nor is gonorrhoea very fre- 
quent. 

The ulcerative cases amounted to 309 — rather a large 
number, many of which proved tedious and difficult of 
permanent cure ; twenty of them were sent to foreign hos- 
pitals for treatment, and six were sent home invalided. 
The disposition in some vessels to the ulcerative process 
was great, almost every slight accident, abrasion, or small 
abscess, assuming that character. 

There were, as there must always be in the naval ser- 
vice, a great many accidental injuries, bruises, sprains, 
fractures, &c. The number of cases, including every 
lesion which prevented the full performance of duty for 
the shortest period, amounted to 466 ; but a great majority 
of them were trivial. Out of the whole number, three, 
affecting the brain, proved fatal on board; eleven were 
treated in foreign hospitals, and one was invalided. 



YEAR 1881. 

The combined West Indian and North American squa- 
dron enjoyed a high degree of health, if the state of health 
is determined solely by the amount of mortality. In few 
parts of the world, comprising equal numbers and equal 
spaces, will there be found less annual loss of life than 
happened on that station in the year 1831. Out of a 
mean force of nearly 3,000 men, only fourteen died at sea, 
and twenty in hospital, a low number in itself — low when 
compared with other naval stations enjoying higher repu- 



•264 



APPENDIX. 



tation as to climatorial influence on health, and very low 
when compared with its own results on life at some 
other times. When exempt from the peculiar, destructive 
fever, the product of their own soil and climate — and, for- 
tunately, they have frequent and sometimes long-continued 
exemptions from general epidemics — the West Indies 
may be pronounced healthy ; at least, they are not fertile 
in other forms of disease which suddenly destroy life. 
In the year 1831 only one ship suffered from the fever in 
question, in an epidemic form, and that not in a severe 
degree. 

The mean force of the year was 2,901 ; the number of 
vessels was thirty-eight, the great majority of which were 
small, the only ship of the line being the Magnificent, 
employed constantly in harbour duty, with a very small 
complement of men. 

The total number of sick and hurt, including every 
incident, however slight, preventing the discharge of duty 
for any period, however short, amounted to 4,113, being 
at the rate of 1417*7 per 1,000. The ratio is high, even 
startlingly so, at first sight ; but the surprise ceases when 
the trivial force and character of most of the cases, in con- 
nexion with the nature of the service, are considered ; and 
the alarm is speedily and satisfactorily removed by look- 
ing at the death column, where it appears that no more 
than fourteen cases resulted from the whole at sea. 

Of the above entire number of sick and hurt, 248 were 
sent to hospitals abroad, being at the rate of 85'5 per 
1,000, likewise rather a large proportion, but easily 
accounted for on other grounds than the severity of symp- 
toms for which patients were sent there. The number of 
men, as a proportion to the entire sick, sent to the hos- 
pital on this station, will always be large, compared with 



APPENDIX. 



265 



some other stations, from (as was stated in the remarks on 
the tables of last year) the greater facilities which present 
themselves here, hospitals being numerous, for giving sick 
seamen the benefit of those institutions, facilities which 
are properly taken much advantage of. Many diseases 
which have little violence, and no apparent danger — all 
diseases, indeed, can be treated more efficiently and suc- 
cessfully in hospital than on board ship, and the men are 
consequently sooner capable of returning to their duties. 
Hence a sense of economy, as well as of humanity, will 
lead officers to send many not very urgent cases to those 
excellent establishments, our naval hospitals. Abundant 
space, complete repose, appropriate diet, a greater range 
of medicines, and perfect order, combine to render the 
treatment of disease more easy, satisfactory, and speedily 
successful in hospital than on board ships. 

From various ships of the squadron ninety-five men 
were invalided, being at the rate of 32 7 per 1,000 ; and, 
as has been already stated, fourteen died on board various 
ships, yielding the exceedingly low ratio of 4*8 per 1,000, 
or less than one instance of death out of 200 men. But 
twenty deaths occurred in hospital, making a total of 
thirty-four cases of death, and giving the ratio of 11*7 per 
1,000 mortality, afloat and ashore, entire mortality of mean 
strength of squadron. In addition to the ninety-five men 
invalided from ships, thirteen were invalided from hos- 
pitals, making a total of 108 cases of invaliding, and 
giving the ratio of 372 per 1,000 of mean strength. The 
number in this column is certainly considerable, but 
not so large as it will often be found on this station and 
some others. 

The number of all forms, and with whatever degrees 
of force, of idiopathic fever amounted to 508, many of 



266 



APPENDIX. 



them being very slight and transient. Some of them, 
there is little doubt, were simply instances of febrile 
disorder, arising from certain local causes of disturbance, 
rather than cases of fever, in the proper sense of the term, 
and would therefore have been more appropriately placed 
in other columns of the nosological table ; but discrimi- 
nation is not always easy, and thus it happens that fever, 
a term sufficiently comprehensive in itself, is forced 
occasionly to embrace other affections than those legi- 
timately belonging to it. 

The cases of fever are divided into 405 of continued, 
thirteen of remittent, and forty of intermittent. Of the 
first, sixty-eight were sent to hospital, three were inva- 
lided, and eight ended in death at sea ; of the second, 
thirteen were sent to hospital, no one requiring change 
of climate from the station, or ending in death ; and of 
the last, two were sent to hospital, and three were in- 
valided, no one ending fatally. 

The Sparrowhawk suffered considerably from continued 
fever, having had within a few weeks 109 cases, of which 
six terminated in death on board, and one in Port Royal 
hospital, out of seventeen sent there. The disease broke 
out on a passage from Jamaica to Chagres, after touching 
at the Boca Chico, the mouth of the strait leading to the 
city of Carthagena. Fever of the worst form often occurs 
under similar circumstances, viz. ships, after having lain 
some time in Port Royal Harbour, proceeding to Chagres, 
remaining on that coast a while, and then returning to 
Port Royal. In what way the climatorial influence of 
Jamaica co-operates with a similar or separate influence 
on the Spanish Main, in the production of West Indian 
fever, may not be ascertained ; but a great many instances 
might be cited to show that there is such co-operation. 



APPENDIX. 



267 



The fever in the Sparrowhawk was, from the account of 
the symptoms, the pure endemic product of the West 
Indies, though not possessing a high degree of force. Tt 
may be stated, that there does not appear to have been 
any relation between the touching at Boca Chico and 
the eruption of the disease. 

The only additional cases of death, two, resulting from 
fever at sea, happened in the Icarus, and are designated 
typhus, eighteen similar cases having occurred in her. The 
vessel had been employed some time before the occurrence 
of the fatal cases at Tampico, where a portion of the 
crew had been employed ashore. Whatever the exact 
nature of the disease in the Icarus might be, its cause was 
probably derived from that place. 

Although the cases of " inflammation with fever " 
amounted to 1,147, only two out of the whole number 
terminated fatally at sea, viz. one from inflammation of 
the bowels, and one from inflammation of the lungs. 
Without attending to the detail of individual cases, there- 
fore, it may be assumed that a great majority of them were 
slight and unimportant. 

There were, including hemorrhages from, twenty-five 
cases of consumption of the lungs ; of which eleven were 
sent to the hospital, six were invalided, and one ended in 
death at sea. As has been surmised on former occasions, 
it is probable that some of the cases in question were 
chronic bronchitic affections, rather than true tubercular 
phthisis, diagnosis between the forms of disease being 
often difficult. 

There were sixty-three cases of dysentery, ten of which 
were sent to the hospital, one was invalided, and one ter- 
minated fatally at sea. Neither the number affected, nor 
the resulting loss, requires remark. 



268 



APPENDIX. 



The catarrhal cases amounted to six hundred and eight, 
one of which terminated in death. The number is large, 
but, when the diversified climate embraced by the com- 
mand is considered, it is not surprising. 

The diseases included in the order " spasm," consisting 
chiefly of the milder forms of bowel complaint, diarrhoea, 
colic, and common cholera, amounted to 392 ; of which 
eight were sent to the hospital, and ten were invalided, 
none having terminated fatally. It should be noted, that 
the cases invalided were mostly epileptic, epilepsy being 
placed in the order of spasmodic diseases. The bowel 
complaints in this order, (it does not embrace dysentery), 
taking into account the greatly diversified and suddenly 
changing nature of climates in reference to cold and 
heat, were very moderate both in number and force. 

The cases of primary venereal disease amounted to 117, 
viz. sixty-three of syphilis, and fifty-four of gonorrhoea. 
Of the former nine were sent to the hospital, and two 
were invalided ; all the latter being cured on board. If to 
these are added twenty-two cases of bubo and of swelled 
testicle, the entire number of venereal cases will be 139. 
All the last cases had not, perhaps, a venereal origin, but 
granting that they had, the loss to the squadron from this 
source, when compared with some other stations, was 
inconsiderable. 

The ulcerative cases amounted to 235, — a considerable 
number, considering the numerical force of the squadron. 
Out of so many, however, it was found expedient to send 
only six to hospital, and to invalid two ; so that the per- 
manent loss to the squadron was extremely small. The 
temporary loss, from the tediousness of some of the cases, 
was of course considerable. 



APPENDIX. 



269 



YEAR 1832. 

Low as was the rate of mortality within the limits of 
the West Indian and North American command in 1831, 
it is still lower in 1832. The more common forms of 
diseased action were, for the most part, mild and tractable < 
though some of them occurred in large numbers ; and 
pure West Indian fever, the peculiar product of West 
Indian soil and climate, separate and essentially different 
from remittent and other modifications of endemic fever, 
scarcely existed. It certainly did not exist generally or 
frequently, though a small number of isolated cases, 
throughout the squadron, probably occurred. Few if any 
years pass without the appearance of occasional cases, 
nor is it probable that this year was free from them. 
The term u yellow " is applied to a considerable number 
of the fever cases under consideration ; but, as has 
been observed in a former memoir, the designation is 
so loose and improper in itself, and is employed by 
different practitioners in such different senses, that its 
adoption in this, or in any other instance, cannot assist 
the inquirer in determining the amount, or even the ex- 
istence, of the disease. When it is absent, or occurs in 
very small numbers, the West Indian portion of the com- 
mand is not unfavourable to health ; the northern division, 
though it frequently abounds in catarrhal, rheumatic, and 
slight bowel complaints, is not productive of violent and 
destructive forms of disease ; and hence, in this and similar 
years of total, or nearly total, exemption from West Indian 
fever, the united squadron exhibits, and will be found to 
exhibit, favourable returns as to healthy condition. 



270 



APPENDIX. 



The mean annual force of the squadron was 4,613, 
employed in forty vessels of various sizes, the great 
majority of them however being small, some of them of 
the smallest class. There is nothing in these tables lead- 
ing to clear conclusions as to the favourable or adverse 
influence which difference in size and structure of vessels 
exercise on health ; but it is probable, could all the 
minute evidence, which is necessary for the purpose of 
determining, be obtained in this as well as in other 
cases, that the difference in results would not be found 
great, — that the advantages and disadvantages of each 
being nearly equivalent, it would be difficult to strike the 
balance in favour of one class rather than of any other. 
Neither is it possible, from the present reports, or the 
reports of any number of years, to ascertain exactly the 
relative power of different parts of the station on health. 
This arises from the frequent changes of ships from one 
station to another, from south to north, and the contrary ; 
but by far the largest proportion of mortality, even in this 
highly favourable year, resulted from fevers, and all of 
them in the West Indies. 

The entire number of sick and hurt was 5,041. The amount 
is large ; but when it is borne in mind that everything 
which in any way so far disturbs health, whether general 
or local, as to prevent the performance of duty for the day, 
is inserted in these returns,, and that in ordinary circum- 
stances very slight causes are held sufficient for that 
purpose, it will not appear surprising. Out of those, 277 
were sent to foreign hospitals, being at the rate of 76"7 
per 1,000, and 120 were invalided from various ships, 
giving the ratio of 33*2 per 1,000. Only twenty-five 
instances of death happened on board ships, giving the 
very low ratio of 6*9 per 1,000, though a trifling increase 



APPENDIX. 



271 



on that of last year. But the proportion of mortality in 
hospital was smaller this year than last, only fifteen men 
having died out of 277 sent there, making a total of forty- 
one instances of death — the ratio of the entire mortality 
on the station being no more than 11*4 per 1,000 of mean 
strength. In addition to the cases invalided from ships, 
twenty-three were invalided from hospitals, making a total 
of 143 cases, and giving the ratio of 39'6 per 1,000 of 
mean strength. The number invalided is considerable, and 
was so in the two years immediately preceding, to which 
the frequency of periodic fevers and their effects, and 
rheumatism, contributed largely. Yet the loss to the 
squadron, from both sources, death and invaliding, is very 
moderate ; the loss of life, and the probable eventual loss 
to the service, are extremely small. 

Pure fever, and febrile disorders classed with them in 
the surgeons' reports, were numerous, viz. 497, but many 
of them were very slight and transient. In these reports 
the term "slight" is applied to a considerable number of 
them. As has been hinted before, it would be well to 
strike many such cases from the list of fevers, to trace 
them to their local cause, and to give them more appro- 
priate names. The whole are divided into 360 cases of 
continued, forty-nine of remittent, and eighty-eight of 
intermittent, fever. Of the first, fifty were sent to hospital, 
four were invalided, and nine terminated in death at sea. 
Of the second, nineteen were sent to hospital, and two 
were invalided ; and of the last, eight were sent to hos- 
pital, and two were invalided, no fatal case occurring in 
either of them. 

The Sparrowhawk suffered more from fever than any 
other vessel on the station last year : she has likewise sus- 
tained the greatest loss during the present, though the 
fevers, during the two seasons, exhibited different cha- 



•272 



APPENDIX. 



racters, and were derived from different sources. In 1831 
the symptoms characterized the continued concentrated 
fever, which is believed to be a peculiar product of the 
soil and climate of the West Indies and adjacent shores. 
In 1832, the disease, though displaying certain signs 
common to it, and that of 1831, and indeed to all conges- 
tive fevers, was distinguished from the former by striking 
features, and was apparently the consequence of marshy 
exhalations, which often cause in the West Indies, as in 
other places where equal degrees of heat operate, very 
grave and dangerous forms of fever, denominated remit- 
tent, bilious, and bilious remittent. But though such 
fevers are often grave and dangerous, they are not gene- 
rally so destructive as the peculiar form of fever alluded 
to above, and which, for distinction's sake, is here called 
West Indian fever. In 1832, the cases of fever amounted 
to twenty, of which four terminated fatally. The ship 
was anchored in Montego Bay from the 4th till the 21st 
of January. A portion of the ship's company was landed 
for the purposes of protection, the slave population being 
in a state of insurrection, on a property called Unity Hill. 
The men occupied sheds on an eminence, at the point 
where the Great River empties itself into the bay, the land 
at the base, and some distance inland, being a complete 
swamp. The temperature in the night was as low as 64°, 
rising during the day to 80°, the people suffering from 
fatigue, and perhaps from various kinds of excess. No 
combination of things could be imagined more likely to 
occasion certain forms of fever : fever soon made its ap- 
pearance among the shore party, and prevailed to the 
extent stated above, which, considering all the circum- 
stances, cannot be considered great. There was nothing 
in the fevers of other ships on the station calling for 
particular remark. 



APPENDIX. 



273 



The primary inflammations were very numerous, amount- 
ing to 1,445 cases, the great majority of them, however, 
being trifling and transient. Rheumatic cases, and slight 
local affections of the integuments, were very frequent, 
and constituted the largest portion of the entire number. 
Out of the whole, only four ended in death at sea, viz. 
two from inflammation of the lungs, one from inflammation 
of the liver, and one from inflammation of the bowels. 

One case of small-pox, the only one in the squadron, 
which terminated in death, occurred in the Binaldo 
packet. Such a case presents many points of interest, in 
reference to the protecting or modifying power of the cow- 
pock ; but in this instance there is little satisfactory in- 
formation, as it is not stated whether the subject (thirty- 
two years of age,) had been vaccinated, whether all the 
rest of the crew had been vaccinated, or had small-pox ; 
and if vaccinated, whether the cicatrices were considered 
characteristic of the disease. 

There were of consumptive diseases, including hemor- 
rhage from the lungs, twenty-six cases, being nearly the 
average proportion of such cases occurring during a series 
of years in the united squadron. Out of the whole, only 
two terminated fatally at sea, but eleven were sent to hos- 
pitals abroad, and seven were invalided. As regards the 
ultimate issue of cases of true tubercular phthisis, the 
temporary disposal of them need not be much regarded ; 
if all the above cases possessed the positive character of 
that disease, which they probably did not, there can be 
little question but that they all ended in death ; and thus, 
iu a year like the present, would this single disease occa- 
sion more loss to the service than all the other forms of 
disease together. 

Bowel complaints were frequent, but were mostly slight 

T 



274 



APPENDIX. 



and ephemeral. There were thirty-seven cases of dysen- 
tery, 342 of diarrhoea, and eighty-six of cholera, making 
a total of 465, besides a considerable number of cases of 
colic. There were only two fatal terminations out of the 
whole — one from dysentery, and one from cholera; thir- 
teen were sent to hospital, and two were invalided. The 
cholera cases were almost all mild and occasional, the 
consequence of irregularities in diet and of atmospheric 
impressions, common within the tropics. The exception, 
and the single fatal case, was in the Sparrowhawk at 
Quebec. Malignant cholera had prevailed there to a great 
extent ; the ship's pilot was two days ashore in a part of 
the town where the epidemic still lingered ; after returning 
on board, he exhibited the ordinary incontrollable symp- 
toms of the disease, which soon destroyed him. Another 
man who had also been ashore, was affected by the dis- 
ease, but recovered ; it did not proceed farther — no evi- 
dence of contagion presented itself. 

A feature, though not new, presents itself more conspi- 
cuously this year than is common in the now generally 
improved condition, moral as well as physical, of the navy ; 
namely, the comparatively large number of cases of deli- 
rium tremens. This is a painful subject, involving, as it 
necessarily does, the prevalence, to a certain extent, of 
habitual drunkenness. All over the West Indies, as well 
as at Halifax, rum and other intoxicating liquors are 
cheap, and still too generally the object of keen desire 
among British seamen. When on leave, drinking to 
excess is yet a common practice, and, in spite of the 
utmost vigilance, spirits are frequently, and by the most 
singular means, smuggled on board while ships are in 
harbour. Great pains are taken to prevent this, and there 
is no reason to believe that there was any relaxation of 



APPENDIX. 



275 



the preventive measure in 1832 ; yet there were ten cases 
of delirium tremens, two of which terminated fatally at 
sea. The difficulty of preventing absolutely drunkenness 
among sailors is great, and would appear at times almost 
insuperable ; but there is abundant proof of what may be 
done by strict orders of prevention rigidly enforced ; and 
in proportion to the difficulty and importance of the sub- 
ject should be the exertions of officers of all classes. It 
is not easy to estimate the evil inflicted by excessive 
drinking — injuring, as it does, the body and the mind, im- 
pairing the efficiency of the force, interfering with due 
subordination, and, it may be, putting its fidelity in 
danger. The regulation which, some years ago, reduced 
the allowance of spirits to half the former quantity, was 
excellent, and has done much good. Whether the allow- 
ance might be further reduced, and yet be retained, as a 
regular ration, may be questioned ; but there can be no 
question as to whether commanding officers should have 
the power of unconditionally stopping the spirits of indi- 
viduals, on the production of proper evidence, and that 
more as a remedial than a penal measure. The practice, 
too, of allowing every lad, as soon as he is rated, the full 
allowance of grog, should be seriously considered. Such 
a stimulant is not required by them in a dietetic point of 
view, and in every other can act detrimentally only, more 
especially in creating an appetite for intoxicating drink — 
an artificial appetite, which, it is unnecessary to observe, 
grows more rapidly than any other, and is seldom arrested, 
but goes on increasing, till the subject becomes a confirmed 
drunkard. The allowance at first produces partial intoxi- 
cation, and the desire to keep up the excitement continues, 
and becomes more keen, till in too many instances the 
destructive habit is established. 

T 2 



276 



APPENDIX. 



There were seventy cases of syphilis, forty-nine of 
gonorrhoea, and thirty-six of bubo and swelled testicle? 
making 155 cases of venereal disease, of which thirty-one 
were sent to hospital, and one only was invalided. The tem- 
porary loss to the squadron from this source was less than 
it generally is, the permanent almost nothing. 

Though the cases of ulcer amounted to 246, they were 
generally slight, simple, and readily cured. No more 
than eight were sent to foreign hospitals, and six were in- 
valided. There were thirty-six cases in the Ariadne ; it 
is reported that many of them exhibited scorbutic symp- 
toms, though the symptoms are not detailed, and that the 
scorbutic diathesis consequently prevailed in the ship. 
She was a great deal at sea, though not more than many 
other vessels on the station, and therefore not more ex- 
posed to the supposed cause of scurvy, and in no other 
does any scorbutic appearance seem to have manifested 
itself. Scurvy is now scarcely known in the British navy, 
excepting in a few very peculiar cases, such as Polar ex- 
peditions, and in circumstances totally unlike those in 
which the Ariadne was placed. Why it was in any degree 
developed in her, is not easily explained, but it is satisfac- 
tory to know that the developement was extremely trifling. 



APPENDIX. 



277 



Table, 

Showing the Total Number of Cases ; the Number of all Diseases and 
Injuries, in Classes ; the Number Invalided and Dead •, with the Ratio 
of each per 1,000 of attacked. 



Year 1833. 



CLASS AND ORDER OF DISEASE. 


Number 

of 
Cases. 


Inva- 
lided on 
the Sta- 
tion. 


Ratio 
per 
1,000 of 
attacked 


Died 
on the 
Station. 


Ratio 
per 
1,000 of 
attacked 


Febrile Diseases : 












1. Fevers, continued, remittent and 

intermittent 

2. Inflammation, with fever, includ- 

ing acute inflammation of the 
lungs, of the liver, of the bowels, 
and the brain - - - 

3. Eruptive fevers, including erysi- 

pelas, smallpox, and scarlet fever 

4. Hemorrhages, with fever, includ- 

ing consumption of the lungs 
and expectoration of blood 

5. Fluxes, with fever, including dy- 

sentery and acute catarrh - 


805 

1,361 
25 

46 
712 


6 

38 
1 

14 
7 


7-5 

27-9 

40- 

304-4 
9-8 


23 

9 

1 

4 
1 


28-6 

6-6 

40- 

87-0 
1-4 


Nervous Diseases : 












1. Soporose Diseases, including apo- 

plexy, palsy, and some varieties 
of headache - 

2. Defect of vital power, including 

dyspepsia and chronic general 
debility ----- 

3. Spasmodic diseases, including diar- 

rhoea, cholera, colic and epilepsy 

4. jMental diseases i, derangement of 

mind, from whatever cause, in- 
cluding the delirium of drunk- 
ards - 


128 

102 

585 

10 


8 

5 
11 

1 


62-5 

49-0 
18 8 

100- 


3 
8 


23-4 
13-7 


Cachectic Diseases : 












1 . Emaciation of the body, including 

intestinal worms and certain ob- 
scure consumptive diseases of 
the alimentary system 

2. Swellings-, dropsies - - - 

3. Cutaneous diseases, including 

syphilis, scrofula and jaundice - 


17 

16 

147 


3 
2 

6 


176-5 
125-0 

40-8 






Local Diseases: 












1. Diseases of the senses including 

non-inflammatory affections of 
the eye and ear 

2. Depraved appetites - 

3. Ditto - - motions - 

4. Increased discharges, including 

o*rm otvVi rp^ - « - - 

g\J Ll\J 1 X 1 L\JCa> 

5. Obstructions, including constipa- 

tion of the bowels and dysury - 

6. Tumours, including aneurism, va- 

ricose veins and bubo 

7. Protrusions, including dislocation 

and rupture - 

8. Solutions or destruction of parts, 

including wounds, ulcers, and the 
majority of accidental injuries - 


15 
3 
67 
176 

220 
49 

851 


6 
1 

8 

2 
5 

11 


400- 
333.3 

45-4 
9-1 
102-0 

12-9 


1 1 1 1 1 1 1 


6 I 1 III 


Totals - - ■ 


5,335 


135 


25-3 


55 


10-3 



278 



APPENDIX, 



YEAR 1833. 

The health returns of the united West Indian and 
North American Squadron are less favourable in 1833 
than they were in the two immediately precedent years ; 
yet the difference is not great ; the loss sustained is not 
severe, and the ratio of mortality — little more than one 
and a half per cent. — cannot be considered formidable 
throughout a command which comprehends the West 
Indian islands and adjacent coasts. The small compara- 
tive difference which appears against this year depends 
upon the operation of malignant cholera — a new and 
probably transient disease in that part of the world. As 
a destructive and, in many respects, mysterious malady, 
especially in regard to its origin and mode of propagation, 
it cannot, in a notice like this, be passed without observa- 
tion ; but as there is reason to hope that it will soon be 
extinguished, or suspended for a long series of years, in 
the western hemisphere, it does not appear deserving of so 
much study, in the vital statistics of the navy, as the more 
ordinary and permanent diseases which affect seamen. 
Of those, fever, at least in the West Indies, is every way 
the most important, more particularly that form of it which 
in these remarks is denominated West Indian, and which 
is in a great measure peculiar to the West Indies. Though 
there was a great deal of fever in the year 1833, there was 
little, if any, of that in question : hence the inconsiderable 
resulting mortality ; for there are strong grounds for con- 
cluding, that whenever that form of fever prevails, there 
will be, without underrating the value of right treatment, 
great loss of life. 



APPENDIX. 



279 



The mean force of the squadron during the year was 
3,386, the number of ships and vessels of all classes being 
forty-six ; the majority of them, as usual on the station, 
were small ; they were employed in various duties, all of 
them being a good deal at sea, except the Magnificent, 
which is constantly employed in Port Royal Harbour, and 
many of them were, part of the year, in the south, and part 
in the north division of the station. 

The ratio of sickness to numerical force has been high in 
former years on this station, and is still higher in the 
present, being no less than 1575*6 per 1,000. It must not 
be forgotten, however, as has been often observed on this 
subject, that every casualty, however slight, which pre- 
vents duty for any period, is added to and augments the 
surgeon's list. A man may be placed on the list in the 
evening, and discharged from it on the following morning, 
but his name contributes as much to the whole amount as 
that of the man who suffers from fever or from fracture. 
Nor should the nature of the climate comprehended in the 
command be forgotten in considering the subject. The 
sudden and frequent changes in atmospheric heat to which 
the men are exposed, will increase the number, if not the 
force, of certain forms of disease. Whether the structure 
of the station in question, causing increase of less formi- 
dable modifications of disease, lessens total mortality, is a 
difficult, though not, as might appear at first putting it, an 
absurd question. It was glanced at in the first memoir on 
the Tables of this station, and can be only glanced at 
again here ; but it may be stated generally in such a case, 
that increased number of sick and reduced rate of mortality 
are by no means incompatible ; the accompanying Tables, 
if no other proof could be given, sufficiently show it. 

The number of sick and hurt was 5,335, yielding, as has 



280 



APPENDIX. 



been stated, the large rate of 1575*6 per 1,000 of mean 
strength. Out of the whole, 382 were sent to foreign hos- 
pitals, 114 were invalided from various ships, and twenty- 
five terminated fatally at sea. Though the number sent to 
hospital is considerable, it does not, as was formerly 
remarked, and for reasons then assigned, indicate any 
peculiarity or violence of disease : the ratio per 1,000 in 
this column is 112*8. Besides 114 cases of invaliding 
from ships, twenty-one occurred in hospitals, making a 
total of 135, and giving the ratio of 39*9 per 1,000 of mean 
strength. There were thirty cases of death in hospital, 
which, added to twenty-five on board ship, make a total 
of fifty-five cases of death, and give the ratio of 16*3 per 
1,000 mortality of mean strength of squadron. The ratio 
of mortality, though higher than in the two preceding 
years, is not high in itself, and is low when compared 
with many equal periods of time in the same places. The 
number invalided is greater than in the three preceding- 
years, and is certainly considerable in itself. To lose four 
men out of every 100 through this channel is to suffer 
much detriment. Whether it was in every instance 
strictly necessary, is a question which, as it cannot be 
answered, need not be asked ; but it may be stated in 
general terms, that, as has been hinted before, till more 
care is taken in entering men for the service, and a more 
rigid examination is instituted on persons proposed for in- 
validing, the benefit of the measure being reserved abso- 
lutely for men who, on account of health alone, cannot 
discharge their duty, this column in the medical statistics 
of the navy, will always appear larger than can be well 
accounted for, or than it ought to be. It is evident that 
everywhere, especially in climates like that under consi- 
deration, cases will occur frequently urgently requiring 



APPENDIX. 



281 



change of climate, and long or permanent exemption from 
labour ; but it is no less certain, that if invaliding were 
confined to its legitimate object, and granted to legitimate 
subjects only, care being taken not to admit men labour- 
ing under incurable disease, or the pressure of age and 
infirmity, the number of seamen annually invalided would 
be most materially reduced. 

Fevers and febrile disorders were, as usual, numerous ; 
they were even more numerous than in a majority of recent 
years : 805 cases of idiopathic fever are reported, but 
many of them were so slight as to require little treatment, 
little time, and scarcely any confinement. The whole are 
divided into 742 cases of continued, twenty-three of remit- 
tent, and forty of intermittent, the first being arranged 
under the various heads of inflammatory, mixed, typhous, 
simple, and yellow ; but the latter distinctions being often 
arbitrary and insignificant, and consequently uninstructive 
as to the nature and source of the disease, do not demand 
or justify remark. Out of the whole 815 cases, 181 were 
sent to hospital, of which thirteen terminated fatally, five 
ended in a state of health requiring change of climate, and 
ten terminated fatally at sea. ■ Nine of the cases of death 
were from continued fever, the other from remittent. The 
rate of mortality from fever on board ship is little more 
than one out of every 100 affected ; in no part of the world 
will it often be found lower, and in few so low. Including 
the deaths from fever in hospital, the entire mortality from 
this source is at the rate of 6'8 per 1,000 of force, clearly 
showing that the febrile disease had little destructive force, 
and evinced nothing of the maliguant character which 
they sometimes possess in the West Indies. 

As was remarked above, the deeply concentrated, highly 
destructive fever, denominated West Indian, seems scarcely 



282 



APPENDIX. 



to have existed ; whether a case or two may have oc- 
curred, it is impossible to determine. In the fevers which 
prevailed, there appears nothing, in respect of origin, na- 
ture, or effect, calling for detailed observation. In a great 
majority of instances the fever, when independent, not 
symptomatic, was probably the effect of common malarious 
exhalations, allied to marsh miasmata, its occurrence or 
prevalence in different ships being dependent, in some 
measure, on accidental circumstances, such as isolation, 
fatigue, intoxication, and other causes of excess, or priva- 
tion, inducing debility. 

Though the inflammatory affections amounted to 1,395, 
only three out of the whole number ended fatally at sea. 
The greater portion of them were local and very limited 
inflammations of the lower extremities, terminating in 
abscess. Rheumatic cases were next in frequency, and 
were, in many instances, tedious and difficult of cure, in 
some requiring hospital treatment, and in others change of 
climate. Out of the whole 1,395, fifty-seven were sent to 
foreign hospitals, and thirty-four were invalided, the majo- 
rity of both being cases of rheumatism. 

The consumptive cases are fewer than usual. Under 
the heads of " incipient" and " confirmed phthisis," thir- 
teen are reported ; of which, six were sent to foreign 
hospitals, four were invalided, and one terminated fatally 
at sea. There were seven cases of haemorrhage from the 
lungs — a closely allied disease ; of which, two were sent 
to hospital, and one was invalided. Out of thirteen cases 
of phthisis, and seven of haemoptysis, only four were 
left under treatment on board at the end of the year, up to 
which time four were known to have ended in death in 
foreign hospitals. 

There were 712 cases of dysentery and catarrh — " fevers 



APPENDIX. 



283 



with fluxes ;" but no death on board resulted from any of 
them ; twenty-six cases were sent to hospitals abroad, and 
seven were invalided : though the catarrhal cases were 
much more numerous than the dysenteric, the hospital and 
invaliding cases were pretty equally divided between 
them. 

Cholera and choleric affections were rather numerous, 
forty-nine cases having been under treatment. The majo- 
rity of them were without severity or interest, being the 
effect of dietetic and ordinary atmospheric disturbing 
causes. In two vessels, however, the Skipjack and Wasp ? 
the disease had a different character. The first lost three 
out of eight cases, the last four out of twenty-six. In the 
Skipjack the disease broke out soon after her arrival at 
Havaimah, where it was prevailing very destructively 
among the citizens. The two first cases occurred in two 
deserters, who were carried on board in the last stage of 
existence, after which it extended to the number stated. 
Nothing can fairly be deduced from this circumstance as 
to the disease possessing contagious qualities, since the 
cause, whatever it was, which excited it among the inha- 
bitants of the city, might reasonably be expected to pro- 
duce it in a vessel lying close to the shore. 

It is difficult to account for its eruption in the Wasp, or 
to determine its exact nature. It made its appearance 
soon after leaving England for Bermuda, a little to the 
south of Madeira, early in October. Some of the symp- 
toms, especially the suddenness and amount of prostration, 
coupled with the precipitate process by which life was de- 
stroyed, in the fatal cases, seem to connect it with malig- 
nant, asphyxial, or Asiatic cholera. On the other hand, it 
does not appear that certain of the signs considered cha- 
racteristic of the affection, such as lividity, coldness 



284 



APPENDIX. 



of breath and surface, and suppression of the urinary 
secretion, were present. Was it the common autumnal 
cholera of these latitudes in an aggravated form, or was it 
a peculiar disease ? The surgeon of the vessel supposes 
it to have been first excited by atmospheric causes, and 
afterwards kept up by contagion. For the latter hypo- 
thesis there seems to be neither necessity nor strong- 
reason, because the cause, whatever it was, which pro- 
duced it at first, was surely sufficient to support it, as far 
as it went. The disease, as an epidemic, did not last 
more than a week, having run its course between the 2nd 
and 10th of October. 

The returns of the present year, in respect of delirium 
tremens, are gratifying, both on their own account, and as 
compared with last year. Only four cases, and all of them 
so slight as to be cured on board, occurred. They were 
in one vessel, the Arachne ; she refitted at Antigua ; the 
men during the process lived on shore, where they had 
access to spirits, in which they indulged, and which suffi- 
ciently accounts for the disease in this instance: why 
there was comparatively so much of it last year, and so 
little this, is a question very difficult to answer. 

Venereal affections were nearly at the ordinary rate at 
which they are found on the station. There were ninety- 
six cases of syphilis and twenty-two of gonorrhoea; of the 
former twenty-two were sent to the hospital, and three were 
invalided ; and of the latter, two were sent to hospital. 
The majority of the syphilitic cases, as commonly happens, 
occurred in the northern division of the squadron. 

Ulcers were numerous, amounting to 287 cases, twenty- 
one of which were sent to hospital for treatment, and six 
were invalided as unserviceable on the station : they were 
mostly slight, simple, local affections ; but in a few vessels, 



APPENDIX. 



285 



the Rhadamanthus for one, there was tendency to epidemic 
prevalence, with considerable developement of constitu- 
tional symptoms, requiring the application of general 
remedies. The PJiadamanthus had not long arrived in 
the West Indies from England ; and it sometimes happens 
in such cases, that ulcerative diseases become frequent, 
and occasionally, though rarely, formidable, assuming a 
phagedenic or sloughing character, implicating the safety 
of the limb, and even of life. The ulcerative process is 
generally associated in such cases with a plethoric, irritable 
condition of the system, to remedy which, more than to at- 
tend to the local affection, becomes the chief aim and 
duty of the surgeon. 



YEAR 1834. 

The medical reports from the united West Indian and 
North American squadron, during the year 1834, are not 
quite so favourable as were those of the three immediately 
preceding years. The Tables of 1833 gave a higher rate 
of sickness and mortality than those of 1831 and 1832, 
and those of the present year are higher than any of the 
above-named. It is higher also than 1830 in all the 
Tables indicating disease and accidental injuries, and 
their results, excepting that of mortality. Though the 
proportion of sick and hurt is greater in 1834 than it was 
in 1830, the proportion of deaths is less. In 1830 the 
mean strength of the squadron was 3,326, the ratio per 
1,000 of sick and hurt 1524*3, total number of deaths 
seventy-five ; this year the mean strength is 3,636, ratio 



286 



APPENDIX. 



per 1,000 of sick and hurt 1658*7, total number of deaths 
seventy-two, showing, though less strikingly than some 
similar returns, that the rate of mortality has no necessarily 
close connexion with the amount of sickness. But 
though the columns of the present year exhibit higher 
numbers than those of 1831, 1832, and 1833, they are not 
fitted, either alone or relatively, to excite wonder or alarm, 
especially in reference to the amount of mortality, of 
which the ratio is under twenty per 1,000 of mean 
strength. The increased mortality of this year, as com- 
pared with that of the three previous years, depends 
principally upon the greater prevalence and power of 
fevers, and partly on a larger proportion than usual of 
death from accidental causes, — six cases of that kind 
having occurred, three of them from drowning. 

The amount, general distribution, and nature of service 
of the squadron, as well as the force and form of 
ships, were much as they had been for a number of pre- 
vious years. The mean number of men employed was 
3,636, the number of ships and vessels in which they 
served forty-six, all of them, except one ship of the line, 
with scarce any permanent crew, and four frigates, being- 
sloops, schooners, and other craft of the smallest dimen- 
sions, including packets. Most of them were much at 
sea, cruising for the purpose of slave-carrying suppression, 
or making passages from one part of the command to the 
other, and thus visiting alternately the south and north 
portions of it. 

Though the mean numerical force of the squadron was 
not more than 3,636, the number of sick and hurt was 
6,031, being at the rate of 1658*7 per 1,000. This ratio 
is always rather high in the navy, has generally been 
notably high on this station, and is higher this year than 



APPENDIX. 



287 



usual. The circumstances which swell the lists on other 
occasions, and have been noticed before, hold good on 
the present, to which must be added a greater prevalence 
of the causes of fever affecting this period. 

Out of the entire number of sick and wounded, 462 
were sent to foreign hospitals, 136 were invalided, and 
forty-one terminated in death at sea. The first, those sent 
to hospital, yield the ratio of 127*0 per 1,000, the second 
37'4 per 1,000, and the last U S per 1,000 of mean 
strength. But there were, in addition, twenty cases of 
invaliding, and thirty-one of death in hospitals, making 
156 of the former, and seventy-two of the latter ; and thus 
the entire loss to the squadron is at the rate of 42*9 per 
1.000 invalided, and 19*8 per 1,000 dead, of mean strength. 
All of those ratios, except that of mortality, may be con- 
sidered high, that of invalided decidedly so. The remarks 
in reference to invaliding made on the Tables of last year, 
and other occasions, apply equally, if not with greater 
force, to this. The augmented number in the present 
year, even when compared with the last, shows the im- 
portance of the subject in a stronger light, and, in con- 
nexion with the measure of invaliding as a whole, points 
to the great expedience of reforming its laws, as well as its 
practice. 

Under the head of " idiopathic fever," 1,002 cases are 
reported, of which 224 were sent to hospitals for treat- 
ment, fifteen led to a condition requiring change of climate, 
and twenty-four terminated fatally at sea. The ratio of 
mortality from this order of disease is low, being, at sea, 
little more than 2j per cent, of those affected ; and very 
few of all the hospital cases ended in death ; yet, almost 
every third man in the squadron had disease denominated 
fever. It is scarcely necessary to state, that a great pro- 



288 



APPENDIX. 



portion of the whole were slight and speedily cured 
affections, many of them being literally ephemeral, the 
trifling constitutional effect of some local irritation. The 
febrile cases are divided into 865 of continued, forty two 
of remittent, and ninety-five of intermittent fever : of the 
first, 195 were sent to hospital, twenty-two caused death 
on board, and eight, on account of incomplete recovery, 
were invalided ; of the second, nineteen were sent to hos- 
pital, one ended in death on board, and four were inva- 
lided ; and of the last, ten were sent to hospital, one 
ended in death at sea, and three were invalided. 

The Tweed, a corvette of twenty guns, suffered rather 
severely from a disease, in the medical officers' report, 
called yellow fever. Whether it was essentially the same 
as the disease generally understood by that appellation, is 
difficult to determine. It probably was, though modified 
to a certain extent by certain influential circumstances. 
Some symptoms, characteristic of West Indian fever, were 
seldom and sparingly manifested, while others not neces- 
sary to its existence were developed : still, considering the 
entire history and nature of the case, it appears to have 
been the disease in question, though not in a severe form. 
From July till October, when the ship reached a northern 
latitude, there were 159 cases, sixty-one of which were 
sent to hospital, and thirteen terminated fatally on board. 
During the greater part of the time she was employed in 
carrying troops between Jamaica and Nassau, Nassau and 
Belize, returning from the latter place to Port Royal, and 
thence proceeding to Halifax. She was consequently, 
troops being added to her crew, crowded to a certain ex- 
tent which would necessarily interfere with thorough 
ventilation and absolute cleanness. There was at one 
time scarcity of water ; and there were other circum- 



APPENDIX. 



289 



stances, such as prevalent drunkenness among the men, 
and a dirty condition of the holds, &c, (according to the 
medical report,) which might control the common charac- 
ter, and modify or change some of the features of the 
fever. It is not here alleged that such circumstances 
have necessarily or constantly such power ; it is simply 
suggested that they might, in conjunction with other less 
evident but more forcible agency, so far mask the appear- 
ances of West Indian fever, suppressing, in part, some 
symptoms which are common, and producing others which 
do not necessarily belong to it. 

The Skipjack, a schooner with a complement of thirty- 
six men, had ten cases of a disease also denominated 
yellow fever, of which two terminated fatally. The dis- 
ease made its appearance soon after leaving Nassau, where 
she had lain near the Tweed, then affected by fever, and 
from which she had received a man. From these consi- 
derations the medical officer hesitates respecting the 
origin of the fever in the Skipjack, as to whether it might 
not be received, through the medium of contagion, from 
the Tweed. This is not the place for the discussion of 
such a question ; but it may be allowed the Writer to 
observe, that the man received from the Tweed, though 
he had fever in the Skipjack, was not one of the first whom 
it attacked ; that the crew of the Skipjack were much on 
shore at Nassau, where the cause of the disease is often 
developed abundantly, where it prevailed at the time, and 
where they were likely to receive it; and that the ma- 
terials of ships themselves are frequently fertile sources of 
the cause of such fevers, the non-existence of which, in 
the present instance, there is no evidence to prove ; con- 
sequently it is submitted, that there is no argument for 
the operation of contagion here. Besides, the Jackdaw 

u 



290 



APPENDIX. 



and Thunder, small surveying vessels, after a considerable 
absence, anchored during the same season, though later 
in it, at Nassau, for the purpose of refitting. Soon after 
anchoring there, both vessels were attacked by a fever, 
which one surgeon calls yellow, and the other remittent 
fever. It is not known whether the same fever was meant 
to be expressed by the two names, but the disease was 
clearly the same in both vessels, the same as that which 
had been prevalent on the island during great part of the 
year, and probably identical with that in the Skipjack ; 
whether it was the same as that which had been so rife 
in the Tweed, is less obvious. 

Inflammatory affections, the order inflammation with 
fever, were, as usual, numerous. The amount of persons 
affected bore nearly the ordinary relation to those em- 
ployed on this station ; the ratio of hospital cases was 
higher, while that of invalided and of fatal cases was 
lower, than last year. Though the number of men af- 
fected was 1,464, only three out of the whole died at sea, 
seventy-eight being sent to hospital, and forty-six in- 
valided ; a large proportion, about three-fifths of the 
entire number, were slight, superficial inflammations of 
the extremities, having little, if any, constitutional de- 
rangement, and yielding readily, in most instances, to local 
remedies. Rheumatism was frequent, and in many cases, 
as usual, difficult of cure ; invaliding was resorted to in 
twenty-two instances, either for change of climate, or from 
the belief that the subjects were unserviceable. The 
graver forms of inflammation, affecting important internal 
organs, were not numerous, as might be inferred from the 
small mortality noted above. 

Under the head of " phthisis " seventeen cases are re- 
ported, of which six were sent to foreign hospitals, eight 



APPENDIX. 



291 



were invalided, and one terminated in death at sea. 
There were, besides, eleven cases of haemorrhage from the 
lungs, of which four were sent to hospital, and two were 
invalided. The ratio of both forms of disease to force 
does not differ much from what it has generally been found 
to be on the station, taking the average of four or five 
years. Whether all the latter cases depended on tuber- 
cular ulceration of the lungs, present or approaching, and 
whether each of the former was an instance of true tuber- 
cular phthisis, cannot be positively known ; but if both 
questions were answered in the affirmitive, it would be 
easy to tell their terminations ; and thus it would be found, 
though the number affected was not great, the loss to the 
service, through this channel, would be severe. 

The order " fluxes with fevers," embracing this year, 
in addition to catarrhal and dysenteric affections, some 
instances of influenza, give 710 cases, being nearly at the 
common rate in which those forms of disease occur in the 
united squadron. As a whole, however, they were slighter 
and more transient than they often are; there were no 
fatal terminations : nineteen were sent to foreign hospitals, 
and five were invalided. 

There were sixty-six cases of gastric disease, denominated 
cholera. Of the whole number, forty-eight had little inten- 
sity, and no fatal power, being simple, sudden disorders of 
the alimentary organs, producing vomiting and purging, and 
occasional spasms, the results of dietetic errors, or atmo- 
spheric impressions, or of both. The other eighteen, which 
occurred in the President, had a different character, andadif- 
ferent source, whatever that source was, possessing the pe- 
culiar marks which belong to the malignant fever cholera, 
or, as it has been improperly called, Asiatic, on the assump- 

u 2 



29-2 



APPENDIX. 



tion that everywhere out of Asia it is an imported dis- 
ease, having [been carried, in such a case as this, from 
India, over Europe, across the Atlantic, through so long 
and unbroken a chain of contagious intercourse, by 
means of personal contamination. Only three of the 
eighteen men attacked by the disease, the malignant cho- 
lera, died ; a rate of mortality so low, that were the symp- 
toms not clearly detailed, its real nature might be 
doubted. There can be no doubt on that subject; but it 
may be assumed that, in some instances, the cause of the 
disease was not so concentrated and virulent as it gene- 
rally is. It appeared in the ship in August, having been 
found to exist in the town (Halifax) a short time before. 
The surgeon's statement respecting it in the President, and 
certain circumstances connected with its evolution and 
arrestation there and on shore, is interesting, parts of it 
tending to throw light on some of the attributes of this 
mysterious malady. 

The ship was anchored close to the town of Halifax. 
The ship's company, after the existence of cholera in the 
town was ascertained, were not allowed to go on shore, 
though one man, who had been employed at the admiral's 
house, near which place the disease did not exist, was 
sent on board the ship. Two other vessels of war, lying 
near the President, had neither of them a single case of 
cholera. It has been omitted to state whether those 
vessels were further from the shore than the President, and 
what position they occupied in relation to the part of the 
town in which the disease broke out, and then chiefly 
prevailed. Four days after the appearance of cholera in 
the President, she was moved from her original moorings, 
near the dockyard, to a point three miles distant in the 



APPENDIX. 



293 



harbour ; after the change of place, no case of the disease 
occurred. The Rifle brigade had suffered severely from 
the same disease some time in barracks, when they were 
marched to and encamped at the bottom of the bay, a 
distance of several miles ; with the change of place, the 
disease in them also entirely ceased. The same favour- 
able results followed the removal of the 96th regiment 
from barracks, where the disease was committing great 
ravages, to an eminence, distant less than a mile. From 
these striking and combined instances of change of place 
having the power to annihilate cholera, in masses of 
men whose position is thus changed, it may be concluded 
that the cause of it, whatever its nature, is, at any rate, 
for a time, an agent, not only local in the common sense 
of the word, but extremely limited in its operation, being 
capable of acting only on, or very near, the spot whence 
it is evolved ; and that it probably is an emanation from 
the soil, or of the immediate incumbent products of the 
soil, in the place where it operates. 



YEAR 1835. 

The mortality in the united West Indian and North 
American squadron was much greater during the year 
1835, than in any previous year embraced by this Report, 
that is, from the year 1830 to the present. The increased 
mortality is referable to the southern division as its 
locality, and to fever as its proximate cause; the con- 
nexion between the locality and the fever being inherent 
and essential, if the fever in question was the peculiar 
disease which in these remarks is denominated West 



294 



APPENDIX. 



Indian fever ; though it was not so in all cases, it probably 
was at least in the majority of those which caused death. 
This opinion is hazarded on a cursory glance at its general 
aspect, before entering into minute consideration of the 
disease. As it appeared in different vessels, and without 
reference to the names attached to it by different surgeons^ 
which are, as usual, various and conflicting, — bilious re- 
mittent is the name most frequently applied; but there is 
likewise inflammatory, mixed, endemic, yellow, attached 
to the fever, as designating terms. 

The mortality has been progressively increasing through 
a period of five years in the united squadron, the rate of 
increase being proportionate to, and dependent on, in- 
crease in the force of febrile disease. During the first 
three years the increase was inconsiderable, and therefore, 
though it probably had much meaning in an etiological 
point of view, was not likely to attract much observation ; 
but between the two last years, 1834 and 1835, the dif- 
ference w T as striking ; the number of deaths, on comparing 
the latter with the former, being nearly double. Pro- 
gressive increase of this sort in West Indian fever, and in 
other endemic diseases, during a number of consecutive 
years, tending to and terminating in a general distribution 
of its agency, is often observed. It may be represented, 
in a general way, as taking the following course. After 
the lapse of a year or two, in which it can scarcely be 
traced, it occurs rarely and separately during another year 
or two. During another similar period it will arise more 
frequently, but still with considerable intervals of time 
and space; then, connected perhaps with a particular 
state of weather, it bursts forth simultaneously at various 
points of the island and its harbours; the endemic be- 
comes epidemic, attacking at once ships, regiments, and 



APPENDIX. 



295 



citizens, and carrying off great numbers. After such a 
course, though it may linger for a little with greatly re- 
duced force in some places, a period, longer or shorter, 
of exemption ensues. The cause of the disease appears 
to be exhausted for the time, the stock accumulated, so to 
speak, worn out ; and a certain period is necessary to its 
reproduction. 

What is the meaning of this progress ? What is the 
reason why an epidemic, having been extinguished, re- 
appears, first in solitary and detached instances, then 
more frequently and in closer connexion, gathering 
strength as it proceeds, and finally explodes with the re- 
newed power of a sweeping epidemic, again to be extin- 
guished, and again to be renewed ? It would appear that 
the cause of the disease is associated intimately and ne- 
cessarily with a peculiar local influence, a morbific atmo- 
sphere, emanating from, or not far from, the place where 
the disease is excited ; that the local morbific atmosphere 
is occasioned by certain inappreciable actions carried on 
with more or less intensity at or near the surface of the 
earth ; that these actions proceed at different rates at dif- 
ferent times, and under differing modifying circumstances, 
their products being also different, not in kind, but in 
degree ; and that the disease has close, continual relation 
to these actions and their morbific results, being rare at 
their commencement, more frequent as they proceed, and 
rife when they are complete. It is probable that the degrees 
of heat and moisture, and other meteoric agencies, as well 
as local circumstances acting on individuals, influence the 
cause or the subject of the disease, or both, and that they 
have the power of precipitating or retarding, of lessening 
or augmenting, the force of the essential cause. 

The mean numerical force for the year was 3,199, the 



296 



APPENDIX. 



number of vessels forty, both being lower than dining any- 
previous year embraced in this Report. In regard to the 
form and size of the vessels employed, the general dis- 
tribution and nature of service, there was little difference 
as compared with former years, and therefore nothing call- 
ing for remark here. 

The number of sick, being as usual a large proportion 
to the number employed, was 4,724 ; the number of cases 
sent to foreign hospitals was 505 : the number invalided 
was 129, viz. 166 from ships, and twenty-three from hos- 
pitals ; and the number dead was 120, viz. thirty-eight 
on board various ships, and eighty-two in hospitals. The 
first, the number of sick, are at the rate of 1476*5 per 
1,000 ; the second, or hospital cases, are at the rate of 
157*9 per 1,000 ; the third, the number invalided, are at 
the rate of 40*3 per 1,000 ; and the last, or number of 
dead, are at the rate of 37*5 per 1,000, in reference to the 
mean strength. 

All these ratios appear large when viewed by themselves, 
or rather when compared with similar tests in other parts 
of the world, more especially the first and last ; some of 
them are large, and some of them small, compared with 
the results of some preceding years on the same station. 
Thus, comparing the returns of last year with those of the 
present, the rates per 1,000 of sick of mean force respec- 
tively are 1658*7, and 1476 7 ; while of fatal cases the 
rates respectively are 19*8, and 37*5 per 1,000. The rate 
of invalided is lower this year than it was the last and 
some preceding years, but is still high, being upwards of 
40 per 1,000. The rate of hospital cases is higher than 
it was in any of the five preceding years, in consequence 
of the greater prevalence of fever; and the number of 
deaths in hospital is also, from the same cause, much 



APPENDIX. 



297 



greater than usual. The great and striking difference in 
the Tables of this year, as compared with the Tables of 
the five former years, however, is in the increased rate of 
mortality. The increase is occasioned exclusively by the 
increased frequency and force of fever, that disease being 
the cause of nearly five-sixths of all the fatal issues ; 
while other causes of death are less numerous than usual. 
The fevers happened altogether in the South or West 
Indian division of the command ; so that were the num- 
bers employed in the Northern division deducted from 
the numerical force of the entire squadron, the rate of 
mortality, though not so formidable as it often was many 
years ago in the West Indies, would this year be high. 

Under the head of essential fever, no fewer than 1,009 
cases are noted, being at the rate of 31*54 per cent, of the 
number employed. The ratio is very high ; but though it 
necessarily is so, it might probably have been reduced 
considerably, if a number of slight symptomatic febrile 
affections had been omitted, as they might have been 
with propriety. The entire mortality resulting from the 
order of disease is ninety-eight, viz. thirty on board 
various ships, and sixty-eight in hospitals. In the or- 
dinary way of dividing fever into persistent and periodic, 
there are of continued cases 456, of remittent 545, and of 
intermittent nine, with various subdivisions. The general 
results were as follow. Of the first, 137 were sent to 
hospital ; five, from imperfect recovery, were invalided, 
and twelve ended in death at sea ; of the second, 1 77 
were sent to hospital, six were invalided, and eighteen 
ended in death at sea ; of the last, two were invalided • 
the remaining cases of the whole 1,009 were cured on 
board. 

The Vestal, a small frigate-built ship, with a comple- 



298 



APPENDIX. 



ment of 180 persons, suffered much from West Indian 
fever. She had 167 cases of primary attack, of which 
139 were sent to hospital, and three terminated in death 
on board ; twenty-five fatal terminations took place in 
hospital. The disease made its appearance on board 
early in March, in Port Royal Harbour, without much 
severity or frequency, and without exciting alarm ; but it 
speedily became more prevalent, and ere long general, 
with increase of intensity and fatal force. On the 30lh 
of the month the ship was moved from Port Royal Har- 
bour, where, with two short exceptions, she had lain 
nearly four months, and anchored a mile and a half off, 
near a Key — a small, sandy, uninhabited island. The 
change was effected in the belief that the disease depended 
on something derived from the harbour, and that it 
would therefore cease soon after moving the ship to a 
distance. It however went on, after the change of posi- 
tion, with unimpaired frequency and force. It ought to 
be stated that the fever was not connected with want of 
cleanness, of ventilation, or of pure air, in the common 
sense of the phrase ; for the holds had lately been cleared, 
cleaned thoroughly, and white-washed ; windsails were 
diligently employed, and chloride of lime was sprinkled 
on the decks abundantly. Another circumstance ought to 
be stated, not for its rarity, but for its frequency, and its 
importance in considering the cause of this disease, more 
especially in ships. It is this ; almost every person who 
joined the Vestal during the prevalence of fever was af- 
fected by it, but no person leaving her under the disease 
communicated it to another, in another place. And so it 
happens, if not universally, almost universally. Nearly 
every man who joins a ship in such a condition has the 
prevalent disease sooner or later ; but no number of per- 



APPENDIX. 



•299 



sons taken from such a ship, labouring under the disease 
in any stage, or in any force, and placed in a situation 
where the disease does not exist, though in the centre 
of a mass of healthy people, can excite it in a single 
instance. An accumulation of such facts — and there is a 
large accumulation — decides the question of the conta- 
gious power of the fever in the negative absolutely. To 
what, then, in a case like this, is it to be ascribed, not 
only primarily, but secondarily, as well during its pro- 
gress as at its commencement ? The question, sur- 
rounded as it is with difficulties, admits of a very general 
answer only here ; neither the mass of facts, nor the line 
of inquiry which led to the conclusion, can be entered on ; 
but the conclusion is to this effect, that the local mor- 
bific atmosphere alluded to at the beginning of these 
remarks, must be taken into account as an essential ingre- 
dient in the cause ; to which must be added, as another 
essential ingredient, the results of chemical changes 
effected in the structural materials of the ship herself. 
Hence change of place from the harbour to the Keys, or 
any such change, is unavailing to arrest the progress of 
the disease. The Vestal sailed for Bermuda on the 28th 
of April, and the disease finally ceased on the 8th of May, 
in the twenty-seventh degree of north latitude. 

Among the ship's company of the Rainbow, a similar 
ship to the Vestal, though smaller, the disease, without 
prevailing so generally, proved fatal in nearly as large a 
proportion. There were sixteen cases fatal in hospital, 
out of forty-three sent there, the total number of men 
affected being fifty-five. No fatal terminations happened 
on board, almost all the cases being sent to hospital as 
soon as the disease declared itself. The ship had lain in 
Port Royal Harbour six weeks previous to the appearance 



300 



APPENDIX. 



of the fever aboard, which happened in the middle of 
July ; it was not extinguished till the close of October. 
It broke out, as it almost invariably does, in frigate-built 
ships, in the close neighbourhood of the pumps, among the 
midshipmen and marines, and followed its ordinary course 
of progression forward, and afterward. The circumstance 
most worthy of observation in this case was the very 
laudable attempt made to arrest the progress of the fever ; 
the method adopted was more feasible than that em- 
ployed in the Vestal, though the reason which led to its 
adoption was probably not the right one. In the surgeon's 
journal it is stated that the ship's company were removed 
from the Rainbow, after the fever had been some time in 
progress, into the Magnificent, "to have the holds cleaned, 
fumigated, ventilated," &c. — the removal to the Mag- 
nificent seemed to check it, but after a short time it com- 
menced again, particularly with those people who were 
obliged to keep watch on board, (the Hainbow,) the 
marines, midshipmen, &c, though not sleeping there, but 
merely going to keep their watch, and returning when it 
was over." From the death of one surgeon, and the ab- 
sence of another, sick, during the course of the disease, it 
is to be regretted that the account of the whole is not so 
circumstantial and satisfactory as could have been wished, 
and as would have been most desirable. The removal of 
the people from a " sick ship," in a case like the present, 
is a point of great interest both practically and doc- 
trinally. If the removal were to a place in itself free from 
the cause of the disease, the writer of these remarks be- 
lieves that the remedy would be complete, and that with it 
the disease would entirely cease, excepting in such per- 
sons as had imbibed its cause before they left the " sick 
ship." In the case of the Rainbow, the marines, &c., who 



APPENDIX. 



301 



returned to her for the discharge of certain duties, and 
who are said to have suffered particularly after being 
moved to the Magnificent, were evidently exposed by 
such a return, to a certain extent, to the original cause of 
the fever. 

In the Forte (frigate) there were 123 cases, five of which 
terminated fatally aboard ; eight were sent to Port Royal 
hospital. The disease, though causing little comparative 
mortality, and in most instances mild, appears to have 
been the true West Indian fever. It is noticed chiefly on 
account of two circumstances, both of which are so con- 
stantly found connected with the disease on board ship, 
one of them antecedent to, and the other concurrent with, 
its eruption. The antecedent is the cleaning the holds, 
and otherwise most completely cleaning the interior of 
ships. The Forte had been five weeks in Port Royal Har- 
bour undergoing such a process, the people meantime 
living on board the Magnificent. She sailed for Vera 
Cruz on the 11th of June, and three days after the disease 
broke out. The concurrent circumstance is the place in 
the ship where the disease first appears, viz. the imme- 
diate neighbourhood of the pumps. So it was in this ship, 
so it was in the Rainbow, and so it will be found in a 
great majority of cases to be. Are these circumstances 
accidental and insignificant ? It is presumed that they 
are not, but have reference to the cause of the disease, its 
source, and its evolution. 

The Dee (steam-ship) had forty-seven cases of fever, all 
of which were sent to hospital, where eight of them proved 
fatal. There is nothing very remarkable either in the 
number affected, or the resulting mortality ; but there is 
something remarkable in the progress of the disease, as to 
time, in the ship. Instead of occupying, as it commonly 



302 



APPENDIX. 



does, a month, or two or three, the disease, though not 
equally, embraces the greater part of the year. Something 
similar is observable in the steam- ship Rhadamantbus. 
More time and a larger field of observation are required to 
settle the point ; but if such diffusion as to time, in the 
operation of the cause of the fever, were found to hold 
generally in steamers, it would be interesting to inquire 
whether it was connected with the steam, or, rather, with 
the heat which produces it. 

The Thunder (surveying vessel) was noticed as suffering 
rather severely from fever, towards the close of last year, 
at Nassau. The disease continued some time after leaving 
that port for Jamaica, and ran into the present year ; 
three deaths happened on the passage, and four in Port 
Royal hospital. Altogether the loss sustained by this 
small vessel from fever has been severe. 

Other ships, the Belvidera, Flamer, Columbia, Fly, 
Meteor, Larne, Cruiser, Magnificent, and especially the 
Serpent, suffered less or more from fever ; but after the 
above notice respecting ships in which the disease prin- 
cipally prevailed, they present few features worthy of 
notice, and need not be farther particularized. 

With the subject of fever the interest of these Tables 
is exhausted. From all other forms of disease and from 
accidents there were only twenty-two cases which ter- 
minated fatally, eight of which happened at sea, and four- 
teen in hospital. 

The order 66 Inflammation with Fever " was, as usual, 
numerous, giving upwards of 1,000 cases; but from the 
whole number there were only two resulting cases of 
death, one from gout, and one from putrid sore throat, at 
sea — diseases which, though rightly placed according to 
the Cullenian arrangement, are neither of them, strictly 



APPENDIX. 



303 



speaking, instances of pure inflammation, The greater 
part of the whole were unimportant local inflammations, 
and cases of rheumatism, possessing neither pathological 
importance nor fatal force. 

There has been a striking reduction in the number of 
consumptive cases, as compared with the five former years. 
Only nine cases appear under the head of phthisis, and 
two under that of haemoptysis. Taking both forms of 
disease, they are less in proportion than half, while 
phthisis alone is little more than half of any of the pre- 
ceding five years; there was no death on board from 
either form of disease. There is reason to believe that 
the cause of West Indian fever, when generally diffused, 
counteracts the developement of tubercular disease, and it 
appears to exercise similar power of resistance to other 
forms of diseased action. 

Bowel complaints, including dysentery, diarrhoea, and 
simple cholera, though of frequent occurrence, were, with 
few exceptions, slight and unimportant. Out of all cases 
of all these modifications of gastric disease, only two ter- 
minated in death; both cases were dysenteric. Malig- 
nant cholera had entirely ceased. 

There were only two cases of delirium tremens, one of 
which, however, caused death in Port Royal hospital. It 
may be observed, that generally there is more of this dis- 
ease at Bermuda than Jamaica ; the observation applies 
more to the troops and people employed in the arsenal, 
including convicts, than to the Queen's naval force. 
Whether the difference which appears against Bermuda 
depends entirely upon its being less practicable to pre- 
vent spirit- drinking there among those people, or whether 
it is in any measure connected with endemic influence, is 



304 



APPENDIX. 



a question which presents itself, though perhaps difficult 
to answer. 

There were 143 cases of primary venereal disease, 100 
of syphilis, and forty-three of gonorrhoea ; forty- six of the 
former occurred in one ship, the President, employed in 
the northern part of the command. Invaliding was re- 
quired in no one instance, and hospital treatment in very 
few cases. 

The ulcerative cases amounted to 178, of which eleven 
were sent to hospital for treatment, and five were invalided. 
There is nothing in their number, character, or disposal, 
calling for remark. 



YEAR 1836. 

The mortality in the united West Indian and North 
American squadron was remarkably small during the year 
1836 in itself, and as compared with that of 1835. It 
will seldom be found so inconsiderable on that station, 
and on others occupied by the royal navy ; it is often 
greater in the civil population of Great Britain, among 
persons of corresponding ages, and in the absence of severe 
and spreading epidemics. In 1835 the mortality was 
nearly four per cent. ; in 1836 it was under one per cent. 
The difference as to fatal results depended on difference 
in the prevalence and force of fever, being great in the 
former, and trifling in the latter. The cause of West 
Indian fever, the peculiar product of the locality, which, 



APPENDIX. 



305 



through some preceding years, had been becoming pro- 
gressively more generally diffused, and more forcible — from 
whatever source, or through whatever agency — had in the 
year 1835 acquired its highest degree of force and de- 
velopement : the process by which it is formed was com- 
pleted ; it was evolved and exhausted ; and hence the 
extreme rarity or absence of the disease in 1836. In such 
a case the inquirer is compelled to judge by the results. 
It would have been impossible to have foretold, during 
the progress of the disease in 1835, that it would not have 
extended to, and become general, and more violent in 
1836. There were no means of ascertaining that the 
cause had then reached its maximum — the period of ma- 
turation — and that it would consequently cease to act, or 
would act seldom during the following season. In this, 
as in other endemic epidemics, the cause is formed, 
evolved, and becomes operative in different degrees of 
force and frequency at different periods of recurrence. It 
was more generally diffused and more destructive at 
Jamaica in 1825 than in 1835, as it had also been at 
some former periods ; but after what was written on this 
subject, in reference to the epidemic of last year, it would 
be unfit and uninteresting to enter further on it here. 

In the number, size, and form of the ships, the general 
nature of their service, and mode of distribution, there was 
so much similarity to those of former years, that they need 
not be particularized. 

The mean numerical force of the squadron was 3,470 ; 
the number of sick was 4,668, being at the rate of 1345'4 
per 1,000. This ratio, though lower than that of 1835, is 
still high ; but, in considering the relation of sickness re- 
ported to force on board ship, the nature of the employ- 
ment, the liability to accidents, and the general facility of 

x 



306 



APPENDIX. 



being placed on the surgeon's list, arising out of the abun- 
dance of hands, and the humane spirit of the service, must 
be borne in mind. The other ratios, having reference to 
disease and accidents, and their results, including that of 
mortality, are lower than usual on the station, and low 
when compared with similar things in many other parts of 
the world. Thus, the ratio per 1,000 of hospital cases is 
73-23, of invalided 20 5, and of dead 92. The total 
number of deaths was thirty-two, viz. seventeen at sea, and 
fifteen in hospital. The total number of invalided was 
seventy-one, viz. sixty-one from ships, and ten from hospi- 
tals. The loss to the service from death is in every view 
light, whether looked at alone, in comparison with the 
same place at other times, in comparison with other 
stations, or even in comparison with mortality among the 
citizens of places having a high health reputation. The 
loss to the squadron from invaliding is little, compared 
with that of the six preceding years, being at the rate 
almost exactly of the half. It is not easy to account for 
so great difference in this column of these Tables, as it 
often has no very intimate relation to the amount of more 
formidable and fatal forms of disease. Many accidents, 
or rather apparent accidents, may occur to augment or 
lessen the number invalided within a given period ; but 
when invaliding is necessary, the necessity generally 
arises, not so much from a recent attack of disease, how- 
ever severe, or the immediate effect of that attack, as from 
a chronic bad state of health, either direct, or the result of 
one or more attacks of acute disease, suffered some con- 
siderable time before, and leaving, when apparently cured, 
an impaired condition of some organ or organs. Periodic 
fevers are peculiarly productive of such effects on organic 
structure, and therefore are remotely fertile causes of inva- 



APPENDIX. 



307 



liding. Had the fever which prevailed in 1835 been, not 
the continued concentrated fever, here designated West 
Indian fever, but a remittent or other periodic fever, the 
necessity for invaliding, instead of being diminished, would 
have been increased. 

The fevers and febrile diseases designated idiopathic 
fevers, amounted to 402 cases ; of which 286 were conti- 
nued, seventy-four remittent, and forty -two intermittent. 
It is not perfectly clear that the pure, peculiar West 
Indian fever constituted any portion of the aggregate ; it 
is certain that it was rare, if it existed at all. It is equally 
certain that the fevers which did exist were, in a great 
majority of instances, mild, tractable, and transient ; many 
of them, indeed, are denominated ephemeral in the sur- 
geons' reports. From the whole number there were only 
thirteen resulting deaths, six of which happened at sea, 
and seven in hospitals. Ninety cases were received into 
hospitals, not from any general severity of symptoms, but 
on account of the excellent accommodation, and other 
superior means of treatment to be found there. 

The only cases of vessels calling for notice, are those of 
the Carron and Alban, two steamers, which suffered much 
more from fever, in proportion to their complements of 
men, than any other ship on the station. The Alban 
arrived at Jamaica late in the season, and soon after her 
arrival had a considerable number of cases of fever ; of 
those sent to hospital, three terminated fatally before 
the end of the year. In the Carron the circumstances 
were similar. She arrived at Jamaica, though late, earlier 
in the season than the Alban, and had fever soon after her 
arrival. The disease attacked the whole of her small 
complement, most of whom were sent to hospital, where 
two of them died. 

x 2 



308 



APPENDIX. 



It is not easy to ascertain the exact nature of the fever 
in these two vessels. It was stated above, that there were 
doubts whether the pure West Indian fever existed during 
the year ; the doubts had particular reference to the Carron 
and Alban ; they cannot, from any information at present 
possessed, be satisfactorily solved ; but the evidence, as 
far as it goes, preponderates in favour of the opinion, that 
the fever in these steam -vessels was the fever in question. 
And then the important question presents itself — the 
vessels being steamers, and the season not generally pro- 
ductive of the disease — did the heat requisite for the pro- 
duction of steam, precipitate the evolution of the cause ? 
No degree of heat alone can excite West Indian fever, or 
any other fever, in the right sense of the word. But the 
question is — did the heat here, co-operating with the 
endemic morbific influence of the spot, so act upon the 
structural parts of the vessels, as to call into action the 
cause of the disease, which, but for that high heat, would 
have been evolved then, and, under other circumstances, 
might not have been evolved at all ? The question is im- 
portant in itself, and involves another still more important, 
to the following effect. If, as there is reason to believe, a 
high degree of heat is necessary to the production of the 
disease in ships, in so far as it is derived from an internal 
source ; and if high degrees of heat have the power, as 
there is also reason to believe, of precipitating and more 
speedily perfecting the cause of the disease, as acting 
more energetically on their structural parts, contributing 
the results of certain decomposable materials to that effect, 
might not the knowledge of such facts be acted on for the 
prevention of the disease, in so far as it has an internal 
origin, and is occasioned by changes effected in the mate- 
rials of the ships themselves ? The preventive measure 



APPENDIX. 



309 



which suggests itself is, the application of a certain de- 
gree of heat for a certain time to the wooden materials of 
ships, or perhaps more appropriately to the wood of which 
they are to be constructed — say a temperature of 160 
degrees for a month. It is reasonable to infer, that such 
a degree of heat, applied for such a time, would dissipate 
the decomposable matters on which West Indian fever on 
board ship, in many cases, must in some way depend. It 
does not appear probable that the process would act detri- 
mentally on the woody fibre, and impair its durability ; 
nay, it might improve the one, and increase the other. 
That in many cases, and the worst cases, West Indian 
fever is essentially connected with some agency in the in- 
terior of ships, altogether independent of personal commu- 
nication, or collections of extraneous matters, all discrimi- 
native experience shows. To determine, not the nature, 
but the source of that agency, and to find a method of 
preventing it, will be admitted to be matter of first-rate 
importance, in an economical as well as in a humane 
point of view. 

The original inflammatory affections were numerous, 
viz. 1,161, but were for the most part trivial and transient ; 
only two cases out of the whole number terminated fatally ; 
sixty-four were sent to hospital, and twenty-three were in- 
valided. A great majority of the whole consisted of slight, 
local, superficial inflammations, scarcely, if at all, con- 
nected with fever ; rheumatic cases were next in order of 
frequency, and formed another large portion of the whole, 
serious inflammations of important organs being compara- 
tively rare. The number invalided from this order of 
disease (inflammation with fever) is large; it is, in fact, 
more than half of the total number for whom that measure 
was deemed necessary ; but as it includes rheumatism 



310 



APPENDIX. 



and certain affections of the air- passages, and of the liver, 
which are generally tedious and troublesome, and some- 
times intractable on the station, the amount is perhaps not 
excessive. 

There were twenty cases of phthisis, of which eleven 
were sent to hospital, three were invalided, and one termi- 
nated in death at sea; and nine cases of haemoptysis, of 
which three were sent to hospital, one was invalided, and 
one terminated in death at sea* On referring to the report 
of last year, it appears that there were nine cases of the 
former, and two of the latter ; and thus it appears, that in 
comparing 1835 with 1836, phthisical cases were as one 
to two, and haemoptysical cases as one to four nearly. In 
1835, the consumptive cases were strikingly low, as the 
fever cases were notably high, in relation to preceding- 
years, from 1830 inclusive; and this year the same anta- 
gonist forces, so to speak, those of febrile and tuberculous 
disease, appear to operate ; for while, in comparison with 
former years, the power of fever is least, that of consump- 
tion is greatest. 

Bowel complaints, including diarrhoea, dysentery, colic, 
and cholera, were, though numerous, remarkably slight 
and tractable ; out of the whole there was no case which 
terminated in death, or required change of climate, and 
only eight persons were sent to hospital. 

Three men had delirium tremens, one of whom was sent 
to hospital, where he recovered. 

The venereal affections were fewer and less severe than 
during any former year since 1830 ; they amounted to 134 
cases, being less than the average number of former years, 
and, taking the whole together, being much under the 
general rate of those affections. 

In simple ulcer there was likewise a considerable re- 



APPENDIX. 



311 



duction, in comparison with former years. There were 
235 cases of all descriptions of non-specific ulcer, as noted 
in the surgeons' reports, though some of them perhaps 
scarcely answered the exact definition. Out of the 235 
cases, eleven were sent to hospital for treatment, invaliding 
being resorted to in two instances only. 

Five deaths resulted from accidental violence, reducing 
the mortality, from disease, to twenty-seven, which is at 
the rate of '72 per cent., little more than seven per 1,000 
of mean force of squadron — a rate, in every point of view, 
remarkably low. 



312 



APPENDIX. 



TABLE FOR SEVEN YEARS, FROM 1830 TO 1836. 

Showing the Total Number of Cases ; the Number of all Diseases and Injuries, in Classes ; 
the Number of Cases sent to Hospital, Invalided, and Dead ; with the Ratio of each per 
1,000 of mean Strength. 





Total number of cases in 
seven years. 


Annual ratio per 1,000 of 
mean strength. 


Total sent to Hospital in 
seven years. 


I Annual ratio per 1,000 of 
j mean strength. 


Invalided from on board in 
seven years. 


Invalided from hospital on 
1 the station in seven years. 


1 Total invalided on the station 
in seven years. 


Annual ratio per J, 000 of 
| mean strength. 


Died on board in seven years. 


j Died in hospital on the sta- 
tion in seven years. 


| Total deaths on the station in 
1 seven years. 


1 Annual ratio per 1,000 of 
| mean strength. 


T 1 ebri.le Diseases* 


























1. Fevers, continued, remittent and 
















2"9 






261 


11*1 


intermittent 


4,932 


209'6 


1,124 


47-8 


5( 


13 


69 


95 


166 


2. Inflammation, with fever, including 


























acute inflammation of the lungs, of 


























the liver, of the howels, and the 














306 


13- 






45 


1-9 


brain - 


9 163 


389'4 


41J 


176 


256 


50 


20 


25 


3. Eruptive fevers, including erysipelas, 


155 




1C 














1 






small-pox, and scarlet fever 


66 


•7 


- - 


2 


2 


•1 


2 


3 


•1 


4. Hemorrhages, with fever, including 


























consumption of the lungs and ex- 












27 


82 




10 


20 


30 


1-3 


pectoration of blood 


333 


14-2 


8? 


3-5 


55 


3-5 


5. Fluxes, with fever, including dysen- 






121 






1 


24 












tery and acute catarrh •* 


4,658 


198- 


5-3 


23 


1- 


6 


3 


9 


•4 


INERVOUS JL/ISEASES. 


























1. Soporose diseases, including apo- 


























plexy, palsy, andsome varieties of 


























headache .... 


768 


326 


4( 


17 


34 


9 


43 


1-8 


11 


3 


14 


•6 


2. Defect of vital power, including dys- 


















pepsia and chronic general debility 


633 


269 


2£ 


12 


48 


5 


53 


2-3 




2 


2 


•1 


3. Spasmodic diseases, including diar- 


























rhoea, cholera, colic and epilepsy 


4,002 


1701 


7b 


3-3 


61 


6 


67 


2-8 


14 


4 


18 


•8 


4. Mental diseases; derangement of 
















mind, from whatever cause, includ- 


























ing the delirium of drunkards 


. 54 


23 


11 


•5 


11 


3 


14 


•6 


3 


1 


4 


•2 


C'ACHKCTIC Ul SEA SE3* 


























Jr. Emaciation of the [body, including 


























intestinal worms, and certain ob- 


























scure consumptive diseases of the 


























alimentary system - 


69 


29 


7 


•3 


20 


3 


23 


1- 


1 


1 


2 


•1 


2. Swellings ; dropsies - 


77 


3-3 


17 


'7 






9 


•4 


1 


1 




3. Cutaneous diseases, including syphi- 


















lis, scrofula, and jaundice - 


866 


36-8 


124 


5*3 


16 


2 


18 


•8 




1 


1 




Local Diseases* 


























1. Diseases of the senses, including 


























non-inflammatory affections of the 


























eye and ear - - - 


80 


3-4 


8 


•3 


22 


1 


23 


•1 




































3. Ditto motions ... 


13 


•6 


1 




5 






•2 










4. Increased discharges,' including go- 
























norrhoea .... 


379 


162 


17 


•7 


5 




6 


•3 










5. Obstructions, including constipation 
























of the bowels and dysury - 


1,177 


50* 


52 


22 


25 


9 


34 


1-4 




2 


2 


•1 


6. Tumours, including aneurism, vari- 
























cose veins and bubo 


1,634 


694 


62 


2-6 


15 


3 


18 


•8 


1 


1 


2 


•J 


7. Protrusions, including dislocation 






















and rupture ... 


381 


16-2 


20 


■9 


47 




47 


2- 










8. Solutions or destruction of parts, 






















including wounds, ulcers, and the 


























majority of accidental injuries 


5,608 


238-31 


2 14 


9-1 


62 


15 


77 ! 


3-3 


18 


17 


35 


1.5 



APPENDIX. 



313 



Years 

1830 - 

1831 - 

1832 - 

1833 - 

1834 ,- 

1835 - 
183C - 



13 a 

bo p 

s-s 

cS <« 

a) O 

3 



3,326 
2,901 
3,613 
3,386 
3,636 
3,199 
3,470 



Total for 7 years 



Total - 
Average 



23,531 



23,531 



$,362 



Deduct for wounds, accidents, and 
slight hurts 

Remain on the list,. &c, from 



Average sick sent to hospital, &c 
from disease - 



13 



.2 S 

Ph o 



5,070 
4,113 
5,041 
5,335 
6,031 
4,724 
4,668 



1524*3 

1417-7 

1395-2 
1575-6 
1658-7 

1476-7 

1345-2 



34,982 



34,982 



4,997 



34,982 



'. 1486-3 



CO 



313 
248 
277 
382 
462 
505 
254 



2,441 



2,441 



WO M 



94-1 
85-5 
76-7 
112-8 
127-0 
1578 
73-2 



349 103-8 



2,441 
134 



30,114 



1,302 



1279-6 



2,307 



97-9 



770 



<u a 

rS O 



H o 



178 
108 
143 
135 
156 
129 
71 



53-5 
37-2 
396 

39- 9 
42-9 

40- 3 
20-5 



150 920 
Invalided 
in Home 
Hospitals 6 



770 



150 



886 



127 



37'8 



181 



fi 50 



22-5 

11-7 
11-4 
16-3 
19: 
37-5 
9*2 



429 
Died in 
Home 

Hospitals 33 



181 



248 



MV2 



66 



462 
35 



427 



18-1 



1486-3 being the average ratio: sick per 1,000 of mean strength, it may be 
list once in abo ut eight months. 



assumed that every man was on 



the sick 



It appears by this table that the annual rate of mortality, 
on an average of seven years, was, from all causes, diseases 
and external injuries, 19 6 per 1,000 of entire force ; and 
from disease, independent of injury, 181 per 1,000. It 
includes, besides the mortality on the station, the deaths 
which occurred in home hospitals, from disease con- 
tracted within the limits of that station; so that thirty- 
three invalids having died in English hospitals, the mor- 
tality from disease on the station was in the ratio of 175 
per 1,000 per annum. 

Comparing the mortality in and from this command 
with that resulting from service in South America, it 
will be found to be, from all causes of death, more than 
double ; from disease distinguished from external causes, 



314 



APPENDIX. 



as 18*1 to 7*7, the proportion of death from disease, in 
relation to accident, being much higher in this command 
thau in the other. 

Yet something more than doubling the mortality of 
South America is not productive of formidable results ; 
nor in this command, the greater part of which is con- 
stituted by the West Indies, and which had epidemic 
cholera, though to trifling extent, added to the ordinary 
causes of death, will mortality at the rate of 18 per 1,000 
per annum appear excessive. When the nature of West 
Indian fever is considered, and the rate at which it some- 
times prevails and proves fatal, the rate of mortality will 
rather, and in opposition to generally received impressions, 
appear small. The most fatal year was 1835, when the 
ratio of deaths, from all causes, rose to 37*5 per 1,000 of 
force, and from fever to 30*6. The following year it fell 
to 9 2 per 1,000 of force, from all causes, including ex- 
ternal injuries. In no year, however, embraced by the 
report, was the prevalence and power of fever so great as 
it had been at some former periods. Though not regu- 
larly, either as to time or force, the peculiar endemic fever 
of the West Indies recurs periodically ; in 1835 it attacked 
and destroyed considerable numbers, the dead by it being 
upwards of thirty per 1,000 of the employed; but it did 
not prevail to the extent, nor was it endowed with the 
force, which it possessed in 1 825, and other former times. 

The annual ratio per 1,000 of sick and hurt was 1486*3, 
the total number placed on the surgeons' lists being 
34,982, and the numerical force of seven years 23,531. 
The proportion of force on the medical lists in the navy 
is always high ; it is higher in this command than some 
others ; but as the reasons have been repeatedly referred 



APPENDIX. 



315 



to in the remarks on annual tables, they need not be 
repeated. 

The number of invalided was also high, viz. 926, being 
in the ratio of forty nearly per 1,000 per annum of force. 
This subject, the general subject of invaliding, has also 
been repeatedly noticed in remarks on annual tables. 
The reduction of active force in the command was, from 
invaliding and death, nearly fifty-nine per 1,000 per 
annum ; so that, though the loss by death, keeping in 
view the nature of the climate, was small, the total 
reduction of number was considerable. Invaliding, from 
the nature of the naval service, and the manner in which 
it is recruited, must necessarily be often resorted to ; but 
it is believed that both the raising and invaliding of 
seamen may be so regulated as to lessen considerably the 
amount of the latter. 

Comparing these ratios of attacked and invalided with 
those in South America, it will be seen that they are con- 
siderably higher, though that of attacked, considering the 
great difference in mortality, is less so than might have 
been anticipated. The annual ratio of sick and hurt per 
1,000 in the South American command was 1310'7; that 
of invalided twenty-eight. Hence, while the reduction 
of force by death and invaliding, in the West Indies and 
North America, was in the ratio of 58*9 per 1000 per 
annum, in South America it was only 36*9. Had South 
America possessed the advantage of hospitals, it may be 
inferred that the loss by invaliding would have been 
considerably less than it actually was. 



INDEX. 



Adrue, virtues of, page 46 
Age, kept in view, 13 

A. I. A., case of, 101 
Anti-contagionists, 29 
Anti-emetics, 46 

Anthony, George, dissection of, 137 
Aphorisms, 68 
Appendix, 253 
Ashmeade, Dr., 38 
Atmosphere, temperature of, 75 
Augusta Fort, medical topography 
of, 161 

Bally, M., synonim of, 1 
Bancroft, Dr., quoted, 4, 15, 32 
Barbadoes, epidemic influenza in 

1733, 244 
Bastien, Jean Francois, quoted, 51 
Bath, medical topography of, 199 
Biddeford, medical topography of, 201 
Blane, opinion of, 4 
Blane, Sir Gilbert, opinion of, 35 
Black troops and pioneers, mortality 

of, 248 
Blood-letting, 40 
Brain, affected in most cases, 22 
Brendelius, quoted, 3 
Buff Bay, medical topography of, 198 

B. G., case of, 129 

Cadiz, fever at, in 1819, 6 
Caledonia, medical topography of, 
205 

Carniola and Hungary, epidemic in- 
fluenza in 1691, 244 
Carthagena, harbour of, 5 

, vomito at, 64 

Cases, temperature of system of, 134 
Cathartics, 47 



Causes, 25 

■, predisposing, 34 

, proximate, 35 

, of the symptoms, 37 

Chapelton,medical topography of,200 
Chardin, quoted, 51 
Chisholm, synonim of, 1 

, remark by, 4 

, accusation of, 29 

Clark, opinion of, 33 
Climate, 25, 26 
Cold affusion, 50 
Concluding observations, 60 

remarks on epidemics, 242 

Contagionists, 29 

Cowan, Dr., 46 

Cullen, synochus icterodus, 1 

, remarks by, 2 

, quoted, 3 

Curry, Dr., favourable to cold affu- 
sion, 50 

Difficulties, neither contemplated nor 

foreseen, 13 
Dissections, conclusions drawn from, 

not satisfactory, 24 
Diseases, tabular of the navy of 1 833, 

277 

Drunkenness, exciting cause, 28 
Emetics, 45 

England, influenza in 1658, 244 

England and France, epidemic influ- 
enza in 1780, 245 

Epidemic influenza, 150 

Epidemics, concluding remarks on, 
242 

Experiments on the temperature of 
system, 77 — 85 



318 



INDEX. 



Exposure to damps, 28 
Eyes, appearance of, 1 7 

Farquhar, Dr., 38 

Falmouth, medical topography of, 186 

Febris intermittens, 129 

Febrile heat, of the preternatural, 86 

Fever, various types of, 68 

Fordyce, Dr., remark by, 4 

9 opinion of, regarding 

contagion, 63 

Fort Augusta, medical topography 
of, 161 

Franck, synonim of, 1 

France, influenza in, 244 

and Germany, epidemic in- 
fluenza in, 244 

and England, epidemic influ- 
enza in 1780, 245 

Fumigations, muriatic and nitric acid, 
58 

Galen, 18 

Gastelbondo, Juan Josep de, de- 
scribed the first epidemic, 65 

G. A., case of, 104 
General summary, 206 

. , table of, 207 

Germany and France, epidemic in- 
fluenza in, 244 

Gibraltar, fever in, 1804, 1813, 1828, 
6 

, 1810, 1813, 1814, 

32 

Gilbert, opinion of, 33 
Gimbernats, fumigations, 57 
Green Castle, medical topography 
of, 200 

Havanna, vomito at, 64 

Hartle's, Mr., account of fever on 

board H.M.S. Pyramus, &c, 143 
Henderson, Dr., opinion of, 4 

H. G. S., case of, 94, 95 
History of the disease, 5 
Hillary, Dr., 45 
Horace, quotation from, 14 
Howel's, Dr., method of preparing 

adrue, 47 

H. P., case of, 116 

's extraordinary case, and re- 
marks, 121—128 

Humboldt and Ingenhouz, remarks 
by, 3 

— , opinion of, 33 

Hungary and Carniola, epidemic in- 
fluenza in, 244 



Jackson, quoted, 36 
James Gray, case of, 111 
James M'D., case of, 130 
Jamaica, epidemic influenza in 1733, 
244 

, epidemic fever in the years 

1822 and 1827, 247 

, mortality among officers, 247 

J. B., case of, 96 

Influenza of 1820, 240 

Johnston, John, case of, 88 

John S., case of, 97 

John N;, case of, and dissection, 

105 

John C, case of, and dissection, 1 07 
John Cochran, case of, 131 
John M'G., case of, 132 
Is it, or is it not, contagious ? 29 

Kingston, Jamaica, population of, 31 
, medical topogra- 
phy of, 139 

Labat, de la, synonim of, 1 
Lancisi Torti, described fevers, 65 
Lacovia, medical topography of, 201 
Leghorn, fever in 1 804, 6 
Lisme, Dr., quoted, 3 
Lind, Dr., 45 

Lucea, medical topography of, 193 

Macbride, synonim of, 1 
Malaga, fever at, in 1 803, 6 
Marseilles, fever at, 7 
Maroon town, medical topography of, 
190 

Manchioneal, medical topography of, 
198 

Mandeville, medical topography of, 
204 

Mercury highly extolled, 48 

Medical topography, 139 

Mexico and Peru, epidemic influenza 

in 1733, 244 
Mercury, extraordinary rise of, at 

Petersburgh in 1782, 245 
Military stations, 1 39 
Moultrie, synonim of, 1 
Montego Bay, medical topography 

of, 189 

Montpelier, medical topography of, 
203 

Mortality of the officers in Jamaica 
in the years 1822, 1825, 1827, 247 

Murchison, Dr., 38 

Murry, Capt., valuable remarks by, 
144 



INDEX. 



319 



Navy, statistics of, 1830, 252 

, 183], 263 

, 1832, 269 

, 1833, 278 

, 1 834, 285 

, 1835, 293 

, 1836, 304 

New York, population of, 31 
Negro race seldom attacked, 34 
Notes, 249 

Observations, concluding, 60 
Opinions of authors, 2 

P. C, case of, 103 
P., Captain, case of, 118 
Peculiarities of the weather, on the, 
208 

Peru and Mexico, epidemic influenza 
in 1733, 244 

Petersburg, extraordinary rise of mer- 
cury in 1782, 245 

P. F., case of, and remarks, 93, 94 

Phoenix Park, medical topography of, 
203 

Pinel, synonim of, 1 

Port Royal, medical topography of, 

and table, 159, 160 
Port Antonio, medical topography 

of, 172 

Port Maria, medical topography of, 
197 

Poland and Russia, epidemic influ- 
enza in 1729, 244 
Pringle, quoted, 3 
Prognosis, 1 1 
Predisposing causes, 34 
Proximate causes, 35 
Prophilaxis, 37 

Prevailing diseases of, 1815, 208 

, 1816, 216 

, 1817, 221 

, 1818, 225 

, 1819, 230 

, 1820, 239 

Pulse, not much reliance on the, 19 
P. W. C, case of, 133 
Pyramus frigate, fever on board of, 
143 

Refrigerants, 53 

Register of temperature of atmo- 
sphere, 75 
Regiment, 92nd, mortality in, 147 

, 50th, mortality in, 147 

, 91st, mortality in, 149 

, 33rd, mortality in, 149 



Remarks on the prevailing diseases 
for the year 1816, 216; do. 1817, 
221; do. 1818,225; do. 1819,230 ; 
do. 1820, 239 
Rosa, Joan Fereyra de, title of his 

work, 65 
Robert B., case of, 134 
Rush, in favour of contagion, 29 
Rush maintains an opposite opinion, 
29 

Russia and Poland, epidemic influ- 
enza in 1729, 244 

Statistics of the navy for 1832, 269 

1833, 278 

1834, 285 

1835, 293 

1836, 304 

Sans Souci, medical topography of, 
199 

Sauvages, quoted, 3 
Sagar, quoted, 3 

Salentini, freed from exhalations, 58 

Santa Martha, fever unknown at, be- 
fore 1729, 65 

Savannah la Mar, medical topogra- 
phy of, 195 

St. Ann's Bay, medical topography 
of, 198 

Salubrity of Jamaica for the negro 

race, 248 
Scotland, epidemic in 1762, 245 
S. C, case of, 97 
Second stage, 9 
Senac, remark by, 2 
Shepherd, Mr., of San Bias, 66 
Shea, Daniel, case of, 88 
Skin, heat of the, 23 
Sleep always favourable, 1 7, 1 8 
Smith, Alexander, case of, 89 
Spanish Town, medical topography 

of, 165 
Stholl, opinion of, 2 
Stage, third, 9 

Statistical table of deaths, 145 
Stoney Hill, medical topography of, 
165 

Statistics of the navy, 253 

for the year 

1831, 263 
Sudorifics, 53 
Synonyma, 1 
Symptoms, 7 

System, temperature of the, 72 
Sydenham, quoted, 74 



320 



INDEX. 



Tables for seven years, from 1830 to 

1836, 312, 313 
Tabular diseases of the navy for 1833, 

277 

Temperature of the system, 72 

of the atmosphere, 75 

of the system, cases in 

illustration of, 88, 89, 91, 92, 93, 
94, 96, 97, 101, 103, 104, 105, 107, 
110, 113, 114, 115, 129, 130, 131, 
132, 133, 134 
Thomson, George, case of, 89 
Tongue, particularly regarded, 17 
Tonics and stimulants, 54 
Townley, Charles, case of, 112 
Tradition of the disease, 5 
Treatment, 38 

Tulloch's, Major, statistics of, 142, 
145, 146 



Unity estate, medical topography of, 
202 

Up Park Camp, medical topograph v 
of, 139 

Valentine, synonim of, 1 
Vestal, H.M.S., fever on board of, 
150 

Vogel, synonim of, 1 
Vomitoprieto prevailed at Vera Cruz, 
64 

Wall, William, case of, 91 
, remarks on the tem- 
perature of his system, 92 
Warren, synonim of, 1 

Yellow fever, oldest description of, 6 5 

, supposed to have two 

different sources, 153 



LONDON : 

PRINTED BV IBOTSON AND PALMER, SAVOY STREET, STRAND. 



